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ACORD ' CERTIFICATE OF LIABILITY INSURANCE DATE'MM'DDYYYY,1 <br />I 09/26/2008 <br />FRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Marsh Risk R Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />4695 MacArthur Court, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />(949) 399-5800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />License #0437153 <br />Newport Beach, CA 92660 <br />60,7996-003-003-O8-09 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Travelers Property Casualty Co Of America 2.5674 <br />Westcliff Medical Labs, Inc <br />AtinRodney Brown INSI;REFE United States Fire Insurance Co. 21113 <br />1821 E. Dyer Road. Suite 100 -- ---- ----- <br />Santa Ana, CA 92705 INSURER <br />INSURER p: <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 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 REDUCED BY PAID CLAIMS. <br />LTR INSRd, <br />TYPE OF INSURANCE POLICY NUMBER <br />POLICYEFFECTIVE <br />POLICYEXPIRATIONI <br />LIMITS <br />_ <br />DATE (MMIDDIYY) <br />DATE (MM/DDIYY) <br />r GENERAL LIABIUTY <br />-_ 630154D589A-TIL-08 <br />10101/08 10/01/09 <br />EACH OCCURRENCE _ _1000 00C <br />_-_-- <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />$ 100,000 <br />PREMISESIEa occ �e) <br />J CLAIMS MADE L_XJ OCCUR <br />MED EXP (An, on rs." $ 5,0ogJ <br />[PERSONAL&ADVINJURY <br />— <br />1,000,000, <br />ILL+$ <br />GENERAL AGGREGATE $ 2,000,000 <br />GENERAI AGGREGATE LIMIT APPLIES PER <br />(PRODUCTS <br />POLICY JE� '� LOG <br />✓ <br />- COMPIOP AG $ 2,00000 <br />AUTOMO&LE UA&CITY-' <br />COMBINED SINGLE LIMIT <br />i$ <br />Z ANY AUTO <br />,�-` <br />(Ea accidenq <br />L <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />I`IlI SCHEDULED AUTOS <br />♦w <br />Pr person) <br />j HIRED AUTOS <br />rill, <br />INJURYNON-OWNEDAUTOSOPER <br />enli <br />III <br />RILY <br />TYDAMAGE <br />I$ <br />(Per acr dent) <br />GARAGEUABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHER THAN-EAACC_$ <br />-_ <br />AUTO ONLY: $ <br />AGO <br />EXCESSIUMBREIJA LIABILITY <br />A <br />OCCUR Li CLAIMS MADE <br />CUP 154D589A-TIL-08 <br />�� <br />10/01/08 <br />'EACH OCCURRENCE �$ 2,000,000 <br />10r'01/09 _ <br />AGGREGATE $ 2,000000 <br />j DEDUCTIBLE <br />RETENTION S <br />-- —-- <br />xi WORKERS COMPENSATION AND <br />14086946242 12/01/07 <br />12/01108 X (INC STA I� OTH- <br />EMPLOYERS'LIABILITY <br />➢ELY LI FIR <br />AN I PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED <br />EL EACH ACCIDENT �$ 1,000,000 <br />L DISEASE - EA EMPLOYE $ <br />SPECIAL PROVISIONS b I. <br />_--1,000,0 <br />E L DISEASE -POLICY LIMIT I $ 1,000,0001 <br />OTHER <br />A Property Liability 1630154D589A-TIL-08 <br />10/01/08 10/01/09 Personal Property 6,185,780 <br />Business Income 25,421,000 <br />nrcr <br />Deductible 5,0001 <br />10 Day Notice of Cancellation for Non -Payment of Premium. Santa Ana Fire Department is included as Additional Insured as required by written contract. <br />CERTIFICATE HOLDER LOS -000684418-11 CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Santa Ana Fire Department EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Attn: Rhoberta <br />1439 S. Broadway <br />Santa Ana, CA 92707 <br />I <br />ACORD 25 (2001108) <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 KIND <br />UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />John Graef <br />O ACORD CORPORATION 1988 <br />