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DATE (MWDDIYYYY) <br />AC—ORD. CERTIFICATE OF LIABILITY INSURANCE 1vo312o0$ <br />_ IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />PRODUCER <br />Marsh Risk &Insurance Services <br />4695 MacArthur Court, Suite 700 <br />(949) 399-5800 <br />License 80437153 <br />Newport Beach, CA 92660 <br />Ili 607996-00240#2-08-09 — <br />INSURED <br />Westcliff Medical Labs, Inc. <br />At(n' Rodney Brown <br />18Z.i, L. Dyer Road, Suite 100 <br />Santa Ana, CA 92705 <br />TH <br />LONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ALTER THE CIOVERAGEICA E DOES NOT AFFORDED BY THE OLJCIES BELOW -ND OR <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A Travelers Property Casualty Co. Of America 25674 <br />INSER a <br />UR. United States Fire Insurance CO. 21113 -- <br />INSURERcNautilus Insurance Company 17370 <br />INSURER D. _ <br />INSURER E. <br />COVERAGES <br />Ir 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 OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY Ia 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 LIM_ ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LIMITS <br />POLICY EFFECTIVE POLICY E%PIRATION' <br />marc .u.v. TYPE OF INSURANCE <br />LTR INSRd <br />DATE(MMmvrrq <br />.. t"1111--1. <br />•j <br />EACH OCCURRENCE <br />100-0000 <br />GENERAL LIABILITY <br />630 15 <br />10!01109 <br />DAMAGETO RENTED $ <br />100,000 <br />A IX i COMMERCIAL GENERAL LIABILITY <br />110/01/08 <br />�REMISESIEa occurence�. <br />MED EXP (Any one Person) $ <br />5,000 <br />_ <br />CLAIMS MADE x._i� OCCUR <br />PERSONALE ADV INJURY $ <br />1,000,00 <br />GENERAL AGGREGATE $ <br />2,000,00 <br />PRODUCTS - COMi AG $ <br />2,000,000 <br />GENERAL AGGREGATE LI MIT APPLIES PER <br />POLICY -� PRO- �i LOO. <br />JECT <br />'I AUTOMOBILE LIABILITY <br />810154D589A-TIL-OS <br />10/01/08 <br />10/01109 <br />COMBINED SINGLE LIMIT Is <br />Ea <br />1,000,000 <br />A <br />X ANY AUTO <br />BODILY '$ <br />ALL OWNED AUTOS <br />P s) <br />irpero <br />�rJ SCHEDULED AUTOS <br />'BODILY <br />HIRED AUTOS <br />INJURY i$ <br />AUTOS <br />�'�/'/'���xPROPERTY <br />(Paraccid <br />- <br />- <br />NON -OWNED <br />YI <br />DAMAGE $ <br />- _ <br />_ <br />(Peracodent) <br />I <br />AUTO ONLY - EA ACCIDENT $ <br />—J <br />GARAGE LIABILITY <br />Irk <br />EA ACO I$ <br />OTHER THAN <br />ANY AUTO <br />(CUP <br />AUTO ONLY AGG $ <br />EXCESSAIMBREUAL (ABILITY <br />154D589A-TIL-08 <br />1010 1108 <br />10101(09 <br />EACH OCCURRENCE '$ <br />2.000.000{ <br />200000❑ <br />A <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />--� <br />I$ <br />ISI DEDUCTIBLE <br />$ <br />RETENTION b <br />N'C STATUS -0T <br />X_ RV MTc. <br />WORKERS COMPENSATION AND <br />-SEA <br />1,000.00 <br />BEMPLOYERS•LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />408696715-8 <br />12!01108 <br />12)01/09 <br />L. EACH ACCIDENT I•° <br />L. DISEASE -EA EMPLOYEE$ <br />1,000,000 <br />OFFICER/MEMBER EXCLUDED' <br />— — <br />L DISEASE - POLICY LIMIT $ <br />1,000,000 <br />Ii yes,ECdescnbe under <br />SPIAL PROb ISIONS ceva <br />OTHER <br />PFP1000006P2 <br />10!01/08 <br />10/01109 <br />Each Claim <br />2,000,000 <br />C Professional <br />Aggregate Limit <br />4,000,000 <br />Liability <br />Deductible <br />5,000 <br />Retro Date 6/131$7 <br />.nncn ev cYMOCCYFMTICPFf1ALPROVIS1ONs <br />j DESCRIPTION OF OPERATIONSRACATIUNsrym <br />enlc�ccneL!jS;C S .•....�- -• -^-- --- -- -- --- — <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 <br />City of Santa Ana <br />20 Civic Center Plaza (M-29) <br />PO Box 1988 <br />i Santa Ana, CA 92702 <br />LOS -000684416-12 <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY NIND <br />John Greer <br />THE INSURER, ITS AGENTS OR <br />