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~- ao03-~-?~7' 7146473345 p • ~ <br />Rpr O1 OB 03:39p Public Works <br />~- ~.,~~~.., ~. „nnNle'nl .~~o. Faxlu tiW-3/8-8361 To. ThamanD A,.2OO3~-~~j'~-a( Date: q/16008 1113 AM Page. ^-~4 <br />A -aco~- a'-rl~ <br />ACORD CERTIFICATE OF LIABILITY INSURANCE <br />~ i °Aoa/oi el <br />PRDaxFR a <br /> <br />Aadreini S Company-South COa&t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY <br /> <br />License 0208825 wno GONPGrta HO RIOHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND <br />EXTEND OR <br />One MacArthur Place, Suite 100 , <br />~ ALTER THE COVERAGE AfFORDED 8Y THE POLICIES BELOW. <br />South coast xetxo CA 92707 <br />Phone: 714-327-1400 Tar:714-327-1499 <br />INShREN ~ }INSURERS gFFORDING COVERAGE lu ~q <br />~- 1_q <br /> 'N~"°" ~ uFncrn c.Fw:<y coapany .f __ 20427 <br /> <br />clinical Lahoratories of ^JF_FP LAn<mentLL G,wllY Ceyarv/ ~- ~ -~ <br />-- - -- <br />x H2Bno, Zac. <br />P <br />SS llsuaE:~' -` - <br />O. <br />O <br />San Bernardino CA 92402 ~'""""- __ _ _ _ <br />_. -. <br /> a. REF ~ <br />c.nvcRAr.Fc <br />"+ ,tL.r sLRw.. ri VCCL '..rwJ reEM1'IS U' ~--ms[1-.~ .__~e.a 'R cH~Lr-'~rC ~. i., iAFEO NtN,H~tardE"rc <br />; <br />W I FT rN 17 7E M PL-'p'I /J ' CM11P4:1 I t L' 1mG <br />' , <br />l f?-6 4 M 4LS Le E NY EE I$$LGC L^Z <br />~~ r w <br />_ a rF_~E n Fu'Lre c IHee L;w~I 1 r ~~ 1 I, 0 1 JE FJC I= L,rn r roao a. F 2e~: <br />_ <br />p:.l i_..~Ulp,{cir l.a p3T.~\N MP1 n9yFNrPp'6: U'LtGB`NA'h:A!-p~ <br />~ - _- <br />LTRN <br />sRV 'VpE OF INSURANCE POLICYMIMRER <br />~LI~R~PDLT~q~Q~Qpr~p~~- - <br />- <br />~-~~ <br />~ <br />R <br />_ ~ <br />D2 <br />F IMMA]0 <br />tE (NW0DRT <br />I LIMTS <br />) <br />GENERAL LIABNTV I <br />~ ~ <br />4H0 Ina:^aE a1 <br />O00 <br />DOD <br />A <br />X X ti MYI ,u Er.EO4 0 L'n' TCA206S975201 , <br />, <br />02/01/08 <br />02/01/09 c Ft~~~~`E „ 5100 <br />000 <br />J EL IM arr ~ X I .;.vt ~ <br />~ ~ <br />, <br />I ~ - <br />J I -E[_, rv .n m..~,: 510,000 <br />~ ~ 1 IF rnAnIV9. s'v@'A.~~R_ ~1,DDDrDDD <br /> IEEALAC hraAre ,a <br />DaD <br />ooo <br />EN', \. .j.. :l \I. h •LiEb'°ER , <br />, <br /> <br />µ;E 51[U IS f`•.F' P.y=: <br />5 Excluded <br />x •'t l..~.,<* ~h,. <br />- _ <br />~_ I ,FaLp Ben. 1,000,000 <br />- <br />~- <br />- - <br />auroEloecE LMelutt + <br />- <br />I <br />r` 'ifs IBUA2D69975D94 <br />h ""' I, ;~aa;cae.a; ~s 1,000,000 <br />02/01/08 02/OS/09 <br /> <br />I E ~TSS <br /> <br />~ +LO1LY'TI ~Ir, <br />IP Ual ' 1 <br />~XI RE' <br />~ -,- - <br />I <br />L:1 -I! qV fM1 <br />~ R~ L IDi'~ <br />P xr; > <br /> ~ <br />- i c <br />RUP[PiE C~wNC{ S <br />GARAGE LIABILITY ~' ~ ~ <br />- ~ <br /> N9p J.VLV EA hUr;L~tNf 'S <br />r.. .. - <br /> hEC Iti\ Cn<_L ~5 <br /> FJ r H 'i _. _ <br />E%CESS/UMBRELl0. LIABILITY ~ ~ <br />~ <br /> <br />A ~ X ~" LE ~ -l rcvn vmr ~ CUP206S975399 chH ~ URfEN:. <br />'S$, DOD, OOO <br />~ ' <br />- <br />i <br />L-. ~ <br />02/01/08 U2/Ol/09 G RCf TE <br />L ~ <br /> <br />' E' '..-1 " <br />i <br />- <br />~ <br />F <br /> <br />X RF mvnln i10 <br />00 <br />0 <br />6 <br />_ _ _ <br />L- <br />-, <br />}_ <br />- <br />~ <br />j <br />WONtERSCOMPENSAiIVNAW ~ <br />~ <br />EMYLOYEflS' LIABIL'Y ~ T 4 IM i< `~ <br />fiIC"'HIYrvi Ik-DEL ~llv~ <br /> <br />~ <br />~ <br />I A InC~.rt ! g <br />~ <br />Itln a_ .u. - _ _ <br />.I A ..:.Fi I L 01<I"4 FS FM1'LnYE= j <br />f' ICIL'If_Eelw. ~----- <br /> <br />tOTHER E <br />_ __ V?LICV Lylll 5 <br />-+-- _ _ <br />B Professional EEA275170923 02/OI/OBI 02/01/09 Claim/Aqq 3,000,000 <br />Liahilit (ESO) <br />~ <br />- L_ I Deduct. 100,000 <br />0ESCRRi1pN 0f OPERATION51_0C0.TI0NSt VEHICLESI E%LWBIONS ADDED BY ENDORSEM1LNLi SVE'.IAI PROVISIONS - <br />++REVISES F REPLAC~3 CERTIFICATE ORIGINALLY ISSUED 02/15/08++ <br />Certificate Holder is additional insured as respects to General Liahility <br />per wsrttea contract per attached G-17957-699 <br />The CANCELLATION notice herein is amended t o road 10 dgys as respects nay <br />csacellation due to non-payment of premium. <br />csanclcarE unr nvR _ . _ _ _... <br />CITYSAA SH00.DanT OF THE PBGVE 0ESCRIBEp POlI0E5 BE CANCELLEC BEFORE THE E%PIRATION <br />UATE THEREOF THFBSLANG nSURER WILL EN0EAV0q i0 MAR 3O DAYS WPortEN <br />VUTICE LO THE CfftTIFCAR •OLOER NAMED TO THE LEFT. BUi FAILURE ie DO SO SHgLL <br />City oP Santa Ana <br />Depart$$at Of Pllblie Works IMPOSE Nn OPJ_ICnwN nR UntllLltt aF ANV XINp uPON THE IN811RER, Irs AGENTS OR <br />220 s. Daisey Ave. RErRESfnrnnves. <br />Santa Ana CA 92703 AtrTwR¢EO RDPRE~nTAl~ie _ <br />d~ -- <br />