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ACORD,~ CERTIFICATE OF LIA_BILIT_Y INSURANCE DATE(MM/DDlYYYY)
<br />03/19/2009
<br />aROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Marsh Risk 8 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 />607996-002-002-08-09 URERS AFFORDING COVERAGE
<br />INSURED
<br />Westcliff Medical Labs, Inc.
<br />Attn: Rodney Brown CITY Q~ , `~ T
<br />1821 E. Dyer Road, Suite 100 t~ ~t
<br />Santa Ana, CA 92705 C~E[~T- ~JI t•~ ~,N
<br />INSURER A: I ravelers nuNCny liaauany ~.~...~ ~,~~~~~~.,u
<br />I I~~RERa: United States Fire Insurance Co.
<br />NAIC# _I
<br />25674 i
<br />fa`~' u~ C: Nautilus Insurance Company 117370 I
<br />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 />li NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE
<br />..... __ ._-..._.. ,.., ...., r,~r,r~,.~ ruc ir.ic~ ronnrro econonFn av TNF cnl iclFS nFSCRIBED 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'4 ',,
<br />TYPE OF INSURANCE POLICY NUMBER OLICY EFFECTIVE I POLICY EXPIRATIONI LIMITS
<br />DATE (MMlDDIYY) 'I DATE (MMlDD/YY) '
<br />LTR i INSRq
<br />GENERAL LIABILITY ~~
<br />it A ', __ 1630 154D589A-TIL-08 i EACH OCCURRENCE 1 OOO,OOO
<br />10/01/08 i 10/01/09 DAMAGE ro RENrE~ 100,
<br />PREMISES Ea occurence
<br />
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />~ 0
<br />'
<br />-~-ll r
<br />II CLAIMS MADE C~ OCCUR i
<br />~
<br />~ '~$ S,OO
<br />~, MED EXP (Any one person)
<br />-
<br />- ~ PERSONAL 8 ADV INJURY ' $ 1 ,000,OOOI
<br />I ~ - _
<br />'~,
<br />~ GENERAL AGGREGATE $ 2,000,OOa
<br />_
<br />GENERAL AGGREGATE LIMIT APPLIES PERK PRODUCTS -COMP/OP AGQ~ 2,000,000,
<br />~I
<br />PRO-
<br />POLICY ' JECT ~-1 LOC ,
<br />
<br />~
<br />it A I I~ AUTOMOBILE LIABILITY 1810 154D589A-TIL-O8 j 1 O/O1/O8 ~', 1 O/O1/O9
<br />I' COMBINED SINGLE LIMIT ~ 1 ,000,00
<br />(Ea accident)
<br />ii ~( ,ANY AUTO
<br />~I '~ ALL OWNED AUTOS ~ 80DILY INJURY
<br />F Y
<br />I ~ I~
<br />SCHEDULED AUTOS ~-i ~~U~~~~ AS
<br />{I r r~
<br />T® ~~-.1+..a'+1 ~ ~(Perperson)
<br />-
<br />I 'HIRED AUTOS
<br />III---
<br />~ ~~ I~ i BODILY INJURY 'I$
<br />(Per accident)
<br />~
<br />~ ~ NON-OWNED AUTOS ~ ~
<br />~~ ~
<br />~
<br />~~ C.
<br />~---~, / Ui~-..t
<br />-~-~-' -.~..,...
<br />
<br />~-.•- ROPERTY DAMAGE
<br />..~-/•-•-^-•-~
<br />L,3LlIa. ~t1t'= 3~'IGC.i:~y (Per accident)
<br />~
<br />~GARAGELIA&LITY ,F~SS1St8Tlt .~ ~' ~`~~`~'-iITiO~I AUTO ONLY-EAACCIDENT
<br />~
<br />
<br />~
<br />I ', OTHER THAN EA ACC '$
<br />ANY AUTO
<br />~
<br />~- AUTO ONLY:
<br />GG
<br /> A
<br />EXCESSlUMBRELLALIABILITY CUP 154D589A-TIL-08
<br />
<br />
<br />i 10/01/08 lO/O1/O9 EACH OCCURRENCE
<br />
<br />O OO
<br />2 OO
<br /> ~
<br />' A
<br />t ~I
<br />I CLAIMS MADE'
<br />' ~ AGGREGATE
<br />' $ 2,000,00
<br />.
<br />~
<br />OCCUR
<br />,
<br />I
<br />' ^~~ DEDUCTIBLE
<br />I~ RETENTION $
<br />,WORKERS COMPENSATION AND )( i WC STATU- ' OTH-
<br />' '~, EMPLOYERS' LIABILITY j4O8696715-8 i 12/O1/OS 12/O1/09 .L. EACH ACCIDENT ~ 1,000,00
<br />B
<br />V PROPRIETOR/PARTNERlEXECUTIVE
<br />OO
<br />000
<br />$ 1
<br />I AN
<br />/MEMBER EXCLUDED? .L. DISEASE - EA EMPLOYE ,
<br />,
<br />OFFICER
<br />If yes. describe under
<br />i
<br />~.L. DISEASE -POLICY LIMIT ,,I
<br />$ 1,000,OOO
<br />t
<br />SPECIAL PROVISIONS below
<br />~ I OTHER ~'
<br />, C I Professional PFP1000006P2
<br />10/01/08 10/01/09 , Each Claim 2,000,000
<br /> Aggregate Limit 4,000,000
<br />Liability I
<br />Deductible 5,000
<br />I Retro Date: 8/31!06
<br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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 />I CERTIFICATE HOLDER LOS-000684416-17 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 />City of Santa Ana
<br />20 Civic Center Plaza (M-29) 3~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />' PO BOX 1988 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
<br />Santa Ana, CA 92702 i
<br /> UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br /> Aof MaRrsh RLskE& Insurarw:e SBrvices . ~~'s~~
<br /> John Graef
<br />ACORD 25 (2001!08) p ,acoRU cc~Krciri:pLnc~rv Tana
<br />
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