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ACORD <br />PRODUCER <br />N-2o0S-C(,21 <br />CERTIFICATE OF LIABILITY INSURANCE I 09'MIDD`YYVY, <br />09/26/26/2008 <br />Marsh Risk & Insurance Services <br />4695 MacArthur Court Suite 700 <br />(949)399-5800 <br />License #0437153 <br />Newport Beach, CA 92660 <br />607996-003-003-08-09 <br />NSURED <br />Westcliff Medical Labs, Inc. <br />Attn: Rodney Brown <br />1821 E. Dyer Road, Suite 100 <br />Santa Ana. CA 92705 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE, NAIC # I, <br />INSURER A Travelers Property Casualty On. Of America 25674 <br />INSURER B United States Fire Insurance Co. 21113 <br />INSURER C. <br />INSURER D: - <br />INSURER E. <br />2 _- <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 />INSR ADD`L TYPE OF INSURANCE <br />POLICY NUMBER <br />DATEOLIC (MMIDDIYY) <br />LIMITS <br />DATE (MMIDDNYI <br />LTR INSRD <br />GENERAL LIABWTV <br />A 1630 <br />154D589A-TIL-08 <br />10/01/08 <br />EACHO fURRENCE <br />10/01109 DAMAGe TG RENreD - <br />-- <br />$ <br />000000 <br />100,00q <br />�. - <br />r,OMMERUAL GENERAL LIABILITY <br />I <br />PREMIEESIEan encu <br />_ � <br />OCCUR <br />M ED EXPIAny one pe son/ <br />— _- <br />$ <br />5,000 <br />- -- CLAIMS MADE �X <br />PERSONALB ADV INJURY <br />$ <br />1,006.00a <br />GENE <br />GENERAL AGGREGAT E_IMIT APPLIES <br />~PRODUCTSGCOMPIOP AG <br />$--- <br />2,000,00d <br />POLICY PRO- LOEft <br />ECT <br />I iAUTOMOBILE <br />LIABILITY I <br />COMBINED SINGLE LIMIT $ <br />, <br />,. <br />ISI <br />ANY AUTO <br />ilEa <br />eroman9 <br />ALL DINNED AUTOS <br />BODILY INJURY <br />(Per person) <br />SCHEDULED AUTOS <br />--- ---- <br />- <br />' <br />HIRED AUTOS <br />BODIE'I INJURY $ <br />(Perecciaeru <br />I NON -OWNED AUTOS <br />{{I <br />- -- <br />PROPERTY DAMAGE <br />$ <br />i <br />IPer accldann <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT is <br />EA ACC $ <br />ANY AUTO <br />OTHERTHAN <br />- - <br />1 <br />AUTO ONLY: AGG $ <br />IEXCESSIUMBRELLALIABILITY <br />CUP 154D589A-TIL-08 <br />10/01/08 <br />10/01/09 <br />EACH OCCURRENCE $ <br />_2_,000,000 <br />A � <br />ll1 OCCUR L_ CLAIMS MADE <br />AGGREGATE $ <br />-- -- <br />2,000,001 <br />- - <br />$ <br />I DEDUCTIBLE <br />$ <br />- <br />RETENTION $ <br />WORKERS COMPENSATIO N AND <br />40$6946242 <br />12/01/07 <br />12/01/08 X WC STATU- DTH- <br />- _.TORY MITS��R <br />EMPLOYERS'LIABIDTY <br />E L. EACH ACCIDENT Is <br />1,000 006. <br />4NY PROPRIETORIPARTNER`EXECUTIVE <br />CFFICERIMEMBER EXCLUDED' <br />LL DISEASE - EA EMPLOYE $ <br />_ <br />1,000.00q <br />LDISEASE- POLICY LIMIT $ <br />1,000,000 <br />If yes, descrbe under <br />SPECIAL PRO NS below <br />OTHER <br />154D589A-TIL-08 <br />10/01/08 <br />10/01/09 Personal Property <br />6,185,780 <br />A Property Liability <br />1630 <br />Business Income <br />25,421 000 <br />Deductible <br />5,000 <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENUeJKSEMEN hSPECiAL 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 -0006_84416-11 CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />20 Civic Center Plaza (M-29) <br />PO Box 1988 <br />Santa Ana, CA 92702 <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 UABIUTY OF ANY KIND <br />John Graef <br />THE <br />O ACORD CORPORATION 1988 <br />