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STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />F U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />FEBRUARY 1, 2G09 POLICY NUMBER: 1$86779 - 09 <br />CERTIFICATE EXPIRES: 2-1-10 <br />CITY OF SANTA AKA <br />DEPARTMENT DF PUBLIC iiDRRS <br />220 S DAISY AVE <br />SANTA ANA, CA 92703-4334 <br />JOB: ALL CALIFORNIA OPERATIONS <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California <br />Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. <br />We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy <br />listed herein, Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this <br />certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject <br />to all the terms, exclusions and conditions of such policy. <br />A HORIZED REPRESENTATIVE <br />~- <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OGGURREHG>~. <br />ppRpv I. <br />EMPLOYER <br /> <br />CLINICAL LABORATORIES OF SAN BERHARDIHO ANDlDR <br />GEO MONITOR INC. <br />P. O. BOX 329 <br />SAH BERHARDIHD~ CA -:924x2.... <br />l ~~~--- <br />"" e~ `~ <br />Laura Stitt `~~` nctzc4 <br />(;ity <br />Asyistaot <br />#596 <br />SCIF 10262 (REV. 02-08) <br />