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.ACORQ. CERTIFICATE OF LIABILITY INSURANCE OP ID V DATE(MM/DD/YYYY)
<br />- CLINI-1 05 31 07
<br />'ROdUC~R ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />!~ndreini & Company-South Coast ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />one MacArthur Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />South Coast Metro CA 92707
<br />Phone:714-327-1400 Fax:714-327-1499
<br />NSURED
<br />A _ ~C~3 -a3°i
<br />Clinical Laboratories of ~ ~~00,~ '07,3'''/-
<br />5an Bernardino, Inc.
<br />P.O. Box 329
<br />San Bernardino CA 92402 ~ , ~~ ~ ~(
<br />INSURERS AFFORDING COVERAGE
<br />~ NAIC #
<br />URERA. American Casualty Company of I 20427
<br />INSURERB~ Zenith
<br />Insu
<br />ranee Company
<br />_
<br />_
<br />~INSURERC
<br />-_
<br />_
<br />_ _-__-
<br />SURER D
<br />' __.__ -
<br />SURER E:
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NSR DD' _ -- - I -- - - -- --
<br />LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE- POLICY EXPIRATION I
<br />DATE MMIDD/YY DATE (MM1DD/YY
<br />LIMITS
<br />GENERAL LIABILITY ;EACH OCCURRENCE $ 1, OOO, 000
<br />
<br />A X ~' X j COMMERCIALGENERALLIABILITY
<br />TCP2068975201
<br />02/01/07 ~
<br />02/01/08 YAI91A-GE T0- RENI~ Ems..
<br />PREMISES (Eaoccurence)
<br />$ 100, 000
<br />CLAIMS MADE ~}(, i OCCUR MED EXP (Any one person) $ 10 , 0 0 0
<br />
<br />~
<br />I
<br />PERSONAL&ADV INJURY -
<br />$1,000,000
<br />
<br />V ~ GEivERAL Au R GATE $ 2 , OO O , C O O
<br />GEN'L AGGREGATE LIMIT APPLIES PER~.I
<br />II' , PRODUCTS COMPlOP AGG
<br />...
<br />- $ Excluded
<br />I$ i POLICY
<br />
<br />I I JERCOT- LOC I
<br />
<br />I I IF
<br />-- -
<br />Emp Ben.
<br />----
<br />Z, 000, 000
<br />AUTOMOBILE LIABILITY
<br />
<br />9
<br />li ~
<br />COMBINED SINGLE LIMIT 1$ 1, 0 0 0, 0 0 0
<br />I (Ea accident)
<br />A ANVAUTO BUA2068
<br />75084 02/01/07 i 02/01/08
<br />~ ALL OWNED AUTOS I ' I i BODILY INJURY
<br />-
<br />SCHEDULED AUTOS
<br />'
<br />I ~ I
<br />I
<br />~
<br />II (Per person)
<br />- -- -
<br />I $
<br />
<br />}~ ', HIRED AUTOS
<br />~,
<br />
<br />~ ~, F-
<br />-- --- -
<br />'. BODILY INJURY ~--
<br />
<br />
<br />$
<br />I $ ~. NON-OWNED AUTOS ~ (Per accidenll
<br />'I
<br />__ i
<br />l _- _ .. ___--.. _.
<br />
<br />_---. - __ ~
<br />j i
<br />~
<br />~
<br />I
<br />~ PROPERTY DAMAGE ~~,
<br />~ (Per acadenq
<br />i
<br />$
<br />GARAGE LIABILITY
<br />-
<br />~ AUTO ONLY - EA ACCIDENT '~
<br />- - - -- $
<br />---' ---- -
<br />~ ~ ANY AUTO I I EA ACC I
<br />OTHER THAN _
<br />~ r
<br />$
<br />r
<br />~ --
<br />~ - ~,' ,AUTO ONLY
<br />AGG~, $
<br />'~ EXC ESSIUMBRELLA LIABILITY , EACH OCCURRENCE $ 5 , O O O , O O O
<br />A X OCCUR ~ CLAIMSMADE f CUP20689753444 ~ 02J01/07 ~ 02/01/08 j AGGREGATE I $
<br />
<br />~ DEDUCTIBLE $
<br />~, }( '~~RETENTION $lO, OOO ~ r ~ $
<br />WORKERS COMPENSATION AND ~ X j TORY LIMITS j
<br />~ ER
<br />
<br />EMPLOYERS' LIABILITY
<br />B 10066924302
<br />ANY PROPRIETOR/PARTNER/EXEGUTIVE
<br />
<br />02/01/07
<br />~ .
<br />
<br />02/01/08 IEL.EACHACCIDENr _
<br />---
<br />sl,Opp,OpO
<br />
<br />OFFICER/MEMBER EXCLUDED? ~
<br />I _
<br />_ _
<br />E L UiSEASE - FA EkIPLOYEE' _
<br />$ 1, 000 , 000
<br />If yes, descnbe under '~, I, --- ~ ---- -- -- - --
<br />I SPECIAL PROVISIONS below ', E L DISEASE -POLICY LIMIT $ 1 , 0 00 , 00 0
<br />OTHER
<br /> i
<br />I
<br />A Property Blanket TCP2068975201 02/01/07 02/01/08 Property 1113000
<br /> ~ S ecial
<br />.+•-.+..•~•• • •.~•~ .+• ..~ ~•~.. ~ wn., • w.... ivies • v n c , cn avrv,~ Huvcu o r cnuvrtacmcrv i ! JYCI.IHL YKV VIJIUlVA . j
<br />Certificate Holder is additional insured as respects to General Liability
<br />per written contract per attached G-17957-G99 ~
<br />The CANCELLATION notice herein is amended to read ZO days as respects~'an ~~- ~/jr`
<br />cancellation due to non-payment of premium
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYSAA
<br />City of Santa Ana
<br />Department Of Public Works
<br />220 S. Daisey Ave.
<br />Santa Ana CA 92703
<br />ACORD 25 (2001108)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MFUL 3 O DAYS WRITTEN
<br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHgLL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br />REPRESENTATIVES.
<br />ATIVE
<br />© ACORD CORPORATION 1988
<br />
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