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ACORD_ <br />. T <br />12//0"'""' <br />0320$ <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Marsh Risk & Insurance Services <br />4695 MacArthur Court, Suite 700 /� 2ONW ^,I �L�� 0 <br />(949) 399-5800 /�' / <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />License #0437153 <br />Newport Beach, CA 92660 ^' <br />607996-002-0,02-08-09 1 V <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Westcliff Medical Labs, Inc. <br />INSURER A: Travelers Property Casualty Co. Of America 25674 <br />INSURER B: United States Fire Insurance Co. 21113 <br />At(n `Rodney Brown <br />182-1 L Dyer Road, Suite 100 <br />Santa Ana, CA 92705 <br />INSURER c: Nautilus Insurance Company 17370 <br />INSURER D: <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT <br />OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN <br />REDUCED BY PAID CLAIMS. <br />ILTRi <br />LTR <br />ADD' <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />OLICY EFFECTIVE <br />DATE (MM/DD/YY) <br />POLICY EXPIRATION <br />DATE (MM/DDfM <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE [XI OCCUR <br />630 154D589A-TIL-08 <br />10/01/08 <br />10/01/09 <br />EACH OCCURRENCE 1.000.00C <br />DAMAGE T( RENTEDEaoccurence <br />PREMISES $ 100,00 <br />MED EXP (Any one person) $ 5,00 <br />PERSONAL & ADV INJURY $ 1 QQQ QQ <br />GENERAL AGGREGATE $ 2,000,00a <br />GENERAL AGGREGATES LIMIT APPLIES PER <br />POLICY JECTPRO- F' LOC <br />PRODUCTS - COMP/OP AG 2,000,00 <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />810 154D589A-TIL-O8 <br />10/01/08 <br />10/01/09 <br />COMBINED SINGLE LIMIT $ 1 000 00d <br />(Ea accident) ���A <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY $ <br />--� <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />a <br />(Per accident) <br />PROPERTY DAMAGE <br />(Per accident) $ <br />GARAGE <br />LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHERTHAN EAACC $ <br />AUTO ONLY: $ <br />AGG <br />A <br />EXCESSlUMBRELLALIABILITY <br />OCCUR CLAIMS MADE <br />CUP 154D589A-TIL-08 <br />10/01/08 <br />10/01/09 <br />1 EACH OCCURRENCE $ 2,000,00 <br />AGGREGATE $ 2,000,00 <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />% <br />B <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORlPARTNERlEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />408696715-8 <br />12/01/08 <br />12/01/09 <br />X WC STATU- OTH- <br />E.L. EACH ACCIDENT $ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00q <br />If yes, describe under <br />SPECIAL PROVISIONS beiow <br />LL <br />k.L. DISEASE -POLICY LIMIT $ 1,000,000 <br />OTHER <br />i <br />I <br />C <br />Professional <br />PFP1000006P2 <br />10/01/08 <br />10/01/09 <br />Each Claim 2,000,000 <br />Liability <br />Aggregate Limit 4,000,000 <br />Retro Date: 6/13/87 <br />Deductible 5,000 <br />DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTlSPECIAL PROVISIONS <br />10 Day Notice of Cancellation for Non -Payment of Premium. The City of Santa Ana, it's officers, agents and employees are included as Additional Insured as <br />required by written contract. <br />CERTIFICATE HOLDER LOS -000684416-12 <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />20 Civic Center Plaza (M-29) <br />PO Box 1988 <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Santa Ana, CA 92702 <br />BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br />UPOZN�D R� THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />UT <br />h Riak&InrxxSBNlcesGraef <br />rJoh�n <br />ACORD 25 (2001 /08) O ACORD CORPORATION 1988 <br />