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/ _ <br />r ~i - ,~ CCU ~ .~' y~ ~~~ <br />From: Dolores Muir FaxID:650-378-4361 Date:4/6!2010 01:24 PM Page: 2 of 5 <br />.!#COR'D~ CERTIFICATE t}F L <br />(ABlLlTY INSURANCE ~LiH~~ DA <br />/ 0 <br />. 04I06 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION <br />Andreini & Company-South Coast ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License 0208825 HOLDER.THI5 CERTIFICATE DOES NOTAMEND, EXTEND OR <br />One MacArthur Place, Suits 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOYI(. <br />South Coast Metro CA 92707 <br />Phone: 714-327-1400 Fax:714-327-1499 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />INSURERA Anarimn Cenueity Cmnpany ar <br />2D427 <br /> INSURER B: contiaantal Casualty canpany 20443 <br />Clinical Labozatories of <br />Znc <br />San Bernardino tNSURERc <br />, <br />, <br />P . 0. Box 329 ; INSURER D: <br />San Bernardino CA 92402 <br /> INSURER E: <br />f:r~V FRdf; FS <br />THE POLICIES OE INSURANCE LISTED BELDW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM INDICATED. NOT W RHSTANOING <br />ANY REQUIREMENT, TERM OR GONDfITON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PE47AIN, THE INSURANCE AFFORDED BY THE POLX:IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOYTIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />'' <br />~ <br />LTR ~~,[ <br />NSR ~_ -- <br />TYPE DF INSURANCE ~ .............~ <br />POLICY NUMBER TE MNVDOtYYVY DATE MMtOD T10N ' LtE1R9 ...__ <br /> GENERAL UA8iU7Y EACH OCCURRENCE S1 OOO,ODO ' <br />A X COMMERCIAL GENERALLIA81l.1TY 2068975201 02/Ol/10 02/O1/11 PREMISE~EdOCCUrerlce 5100 OOD _ <br /> CLAPIiSMADE ~ OCCUR MEOEXP(Artyana,xrsanj S 10,000 <br /> PERSONALEAOV INJURY 31, OOO,DOO <br /> GENERAL AGGREGATE S 2 OOD r OOO <br /> GEN'L AGGREGATE LIMITAP PLIES PER: ' PRODUCTS-COMPlOP AGG sExcluded <br /> POLICY ~ JECT LOC E Bei3 . 1 OOO , OOO <br /> AU TOMOBILE LIA8IUTY CQMSINED SINGLE UMR <br />s1 <br />000 <br />004 <br />A X ANYAUTO 2068975084 02/01/10 ~ 02/01/11 (~Eaaccldentl , <br />, <br /> ALL 04VNED AUTOS 8001LY INJURY <br />S <br /> SCI#OULED AUTOS : (Per person} <br /> X HIRED AUTOS j +)i\`~ V ~ A C' T!l <br />tiJ 1 <br />r <br />J C/\i91, <br />L'l/i\ :, BODILY INJURY I; $ <br /> X NON-0WNEO AUTOS . <br />. j (Per accldsM) <br /> <br /> ' !~'- ~ PROPERTY DAMAGE <br /> _...... <br />~ ~I <br /> <br />~,j ~> >. _. <br /> <br />(Per accldenl) s <br /> GARAGE UAOILtT'Y LaUI St:Ct Sh'eed AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO <br />~~ssist<i <br />t City At(vr <br />, OTHER THAN ~ ACC S <br /> ~ <br />- AUTO ONLY• AGG i <br /> EXCESSJUMBRELLA LW67Lf'rl ~: EACH OCCURRENCE S__Jr ~ GOO, O00 <br />A X occuR Q cLAIMSMADE 20689753444 02/O1/10 O2/O1/11 ~ AGGREGATE s <br /> ~ s <br /> DEDUCTIBLE j <br />_ S <br />~'~ X I RETEMION i O _ <br />_._ S I <br /> WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILRY W TATU- TM-I <br />TORY LIMITS ER <br />' <br /> Y ! N <br />ANY PROPRIETORlPARTNEFtIEXECU <br />' ~'~: E.L, EACH ACCIDENT _ <br />S <br /> OFFiCER <br />MEMBER EXCLUDED? <br />{MandAtofy in NHj <br />EL. DISEASE - EA EMPLOYE!" <br />$ <br /> rt yes, desa~e under <br /> SPECIALPRQVISIONSMaw E.L.OfSEASE-POLICYtIMR' f <br /> OTHER <br />B Professional EEA276170923 02/01/10 02/O1/11 Claim/Agg 3,000,000 <br /> Liabilit {E60} Deduct. 100 000 <br />DESCRIPTION OF OPERATIONS ! LOCATIONS J VEHlCLE91 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECAAI. PROVISIONS <br />Certificate Holder is additional insured as respects to General Liab111ty <br />per attached G-17957-G99. <br />*Supercedes and Replaces certificate issued 2-1-10*** <br />*The CANCELLATION notice herein is amended to read 20 Days as respects any <br />cancellation due to non-payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />~,) <br />City o£ Santa Ana <br />Dept of 7..ri c T~7ark~ <br />220 S. s rP,4~e `~ ~'~' "`" <br />Santa Ana CA 92703 <br />ACOR^ 25 l20A9lD11 <br />All riahtc reserver! <br />SHOULD ANY OF THE A80VE DESCRi8E0 POLICIES 0E CANCELLED BEFORE THE EXPIRATION <br />.SANSANE DATE THEREOF, THE IBS UfNG INSURER WILL ENDEAVOR TO MAIL 3O ...-__ DAYS WRITTEN <br />NOTICE TO THE CERTIPICATE HOLDER NAMED 70 THE LEFT, OUT FAILURE TO 00 SO SHALL <br />IMPOSE NO OBL)GATION OR I,IA8ILITY OF ANY KIND UPON THE INSURER RS AGENTS OR <br />REPRESENTATNES. <br />TbeACORD name and logo are registered marks oiACORD <br />