CLINICAL LABORATORY OF SAN BERNARDINO 11B - 2007

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ACORD CERTIFICATE OF LIABILITY INSURANCE OPID N DATE (MM/DD/YYYY) CLINI-1 02/15/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Andreini & Company-South Coast ~^t License 0208825 /~t '" ~~~i ~'~ ~y ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H . „ OLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One MacArthur Place, Suite 100 ~ ~ ~ ~9 ~ d ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ^ South Coast Metro CA 92707 ~ ~~d '/ Phone: 714-327-1400 Fax: 714-327-1499 INSURERS AFFORDING COVERAGE NAIC # INSURED - (, 11 (~~ ~„ ~J //_ x v V 7 (~ INSURER A: American Casualty Company of 20427 Clinical L b t i f INSURER 6: a ora or es o San Bernardino , Inc . INSURER c: P . O . BOX 32 9 San Bernardino CA 92402 INSURER D: INSURER E: VVVC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER LICY FE TIV DATE MM/DD/YY) P LI Y EX IRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X COMMERCIAL GENERAL LIABILITY TCA2068975201 02/01/08 02/01/09 PREMISES (Eaoccurence) $ 100,000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1 OOO OOO , , GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG , , $ Excluded X POLICY PE ~ LOC Em Ben. 1,000,000 AU TOMOBILE LIABILITY A ANY AUTO BUA2068975084 02/01/0$ 02/01/09 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 i r000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LU\BILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5 ~ 000 ~ 000 A X OCCUR ~ CLAIMSMADE CUP20689753444 02/01/0$ 02/01/09 AGGREGATE $ DEDUCTIBLE $ X RETENTION $ l O, 0 0 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS !VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is additional insured as respects to General Liability per written contract per attached G-17957-G99. The CANCELLATION notice herein is amended to read 10 days as respects any cancellation due to non-payment of premium. r+~ c nvcvcr~ l-AN!'FI ~ ATIrl1U CITYSAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Department Of Public Works IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 220 $ . Dailey AVe . REPRESENTATIVES. Santa Ana CA 92703 AUTHORIZEDR~PR NTATIVE ww '' A!~/'1An n vv vv """"' `" t`~" ""°/ //-~ f`L~~ ~/ ~/ V ©ACORD CORPORATION 1988 G/ ~ /