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MARSH <br />CERTIFICATE OF INSURANCE CERTIFICATE NUMBER <br />LOS -000523409.06 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br />PRCDUCER <br />f.lareh RIS'n 8 IntiDranCC SIE'WCeS <br />NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE <br />POLICY THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE <br />4695 MaCATTI CCUR Suite 700 <br />1979` 399-5800 <br />AFFORDED W THE POLICIES DESCRIBED HEREIN <br />La.P.n Se A0437153 <br />COMPANIES AFFORDING COVERAGE <br />Newpon Beach CA KH60 <br />Atln nrFtInCEre aCCeunISCSS;j-rnafSh Com <br />ccN^=AN <br />A TRAVELERS PROPERTY CASCALTY COMPANY OF AMERICA <br />507996-003-003 07-08 <br />INSURED: <br />A-2006-164-001 <br />.1M-4N <br />B STATES FIRE INSURANCE COMPANY <br />Westcliff Medical Labs Inc <br />JNITED <br />Alin Rodnev Brown. <br />1821 E Over Road S'-iile 103 - <br />" <br />Santa Ana CA 92705 <br />C <br />.: A'I4N' <br />D <br />COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 2 <br />1-.I1 I$ In ]E9II- 1-41 �-p:FF �= INs AANI,F '-S]RIBE] "FREIN'AbE <br />BEEN SS..E] TC T -E INS -RED NAA'ED HEREIN =OR THF �C-C'' P-._RICD I<pICATF:I <br />^:-TNITHSTA+, INGAN.4 LIR=INTENT IERA+.R 'I nITIGN CF ANAITHRESPE TTO-WHIG-i RTFI:ATF M4 BFISS,EDCRN4' <br />CT01 T-_ INti:,+4N :: F"° r'+DE.^. 3` P^b >C.I-I_5 }_5 ]RI3EJ'IERcl41S o: <br />QJ- 'I TO A__ r r -:A i CON.,ITk•N> 4ND tX-'.,S'D%S C- S-,.111 V:IF5 AGGRFGAFE <br />_IK1Ti i-GC.4 Mn �B. E EeE � Rc G.. ;EJ fl � =41:) _.AIAG <br />I <br />OC <br />POLJCYEFFECTIVE POUCYEXRRATION LIMITS <br />TYPE OF INSURANCE POLICY NUMBER <br />LTR <br />DATE IMMIDDRYI DATE(MMIDDIYYI <br />A GENERALUA3U7`( 030 1540589A.TIL-07 <br />'•0.01,07 100108 GENERA, AGGREGATE S 2-000.DOO <br />X -. A.... .<, IIY <br />FR > ...M= -P A.J S 2.000 ,000 <br />1 1 X <br />PERSONAL d A]A INJI,RS 1.000 000 <br />'IFR <br />F4 2`'RF $ 1.000,000 <br />--IRE DWAGE I.., cre I. e, S 100.000 <br />YEDEX=.A-.rnrc scsa• S 5.000 <br />AUTOMOBILE UABIUTY <br />':i:NBINE]51vGE.0.111 $ <br />AN A. T_ <br />4. <br />-SIRED 4..T, <br />1,001_ 1NJ'..R $ <br />Pr as aen. <br />V' m+.'•. Nf �' 4.. FJ5 <br />FRCPERt': DAMAGE $ <br />GARAGE UA&L'.TY <br />-.1 1 _'NL` . Er• 4.,:- S <br />11. A..TG. <br />CTHER T-4NAL.TOON,'1' <br />539-;4— S <br />'IA EXCESSUABILI" CUP 154D589A-TIL-07 <br />10101107 10:01:08 sACn OC;-RRENCFc $ 2.000000 <br />X ,:MBRE—A `LRM <br />AGo4EGAT- $ 2.000,000 <br />S <br />CHEF. T -AN -MBRE --A FORM <br />wORNERS COMPENSATION AND4DB6946242 <br />12'01'07 120108 X 8512'.-5 ER <br />EMPLD PERS' LIABILITY <br />S 1.000000 <br />F- EA-:- A (DENT <br />IB <br />T 1'931'RI TCR x <br />E DIS AS »'C -IC' IMIT S 1.000000 <br />PARTAERSCX..:, al'. i <br />1001000 <br />O H <br />IA Business Personal 630154D589A-TIL-07 <br />1001:07 100108 -ri 6.343.135 <br />Property Blanket Limit <br />Deductible 2.500 <br />DESCRIPTION OF OPERATIONSIIDCATIOFJSNEHICLESJSPECIAL ITEMS <br />10 Dav Notice of Cancellation for Non -Payment of Premium The City of Santa Ana it's officers, agents and employees are Included as Additional Insured <br />as required by written contract <br />CERTIFICATE HOLDER ^ <br />CANCELLATION <br />? <br />j41�-* <br />EPJ 9E ER BE 9E EE e p ERLV <br />,"II <br />N:AIPER IF..9 N C V tI-E 1.1' DFP 7P ]A' jD M C ) iYF <br />Gtr of Santa Ana <br />C. G.!F'.. F ,l'ER _ E4L y-. —RE V L -" —t -a <br />2v civic Center Plaza IM -295 <br />PO BCX 1988 <br />Santa Ana CA 92702 <br />'ascFRor.s: iR11.K'.A`i <br />MARSH USA INC. <br />SIT - John Graef `J • 57 <br />MMt(3102) VAUD AS OF: 12104'07 <br />