Laserfiche WebLink
T T ? <br />From:Dolores Muir FaxID:650-378-4361 Date:4/6/2010 01:24 PM Page: 2 of 5 <br />?Rhr CERTIFICATE OF LIABILITY INSURANCE OP ID DO "TE'M"?DD"r`") <br />CLINI-1 04/06/10 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Andreini s Company-South Coast ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />One MacArthur Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />South Coast Metro CA 92707 <br />Phone:714-327-1400 Fax:714-327-1499 INSURERS AFFORDING COVERAGE NAICk <br />INSURED INSURER A: Ration Cuu?tty Caepaay or 20427 <br /> INSURER B: continental Caamlty C?wzny 20443 <br />Clinical Laboratories of <br />Inc. . <br />San Bernardino INSURER C: <br />, <br />P.O. Box 329 <br />San Bernardino CA 92402 INSURER D: <br /> INSURER E: <br />COVERAGES <br />THE POLICIES DF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD iNDICAIED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YYYY DATE MNMtOIRA QN <br />DffYYY) I LINUTS <br /> GENERALUABIUTY EACH OCCURRENCE 31,000,000 <br />A $ COMMERCIAL GENERALLIABUTY 2068975201 02/01/10 02/01/11 PREwss-Ea0=4TE M s 100 DOD <br /> <br />CLANS MADE XX OCCUR <br />MEO EXP (Any ane Person) _ <br />$10,000 <br /> PERSONAL AAOVINJURY 31,000 000,000 <br /> GENERAL AGGREGATE: %2,000,000 <br /> GENL AGGREGATE UMITAPPLIES PER: PRODUCTS -COMPIOP AGO Is Excluded <br /> POLICY [7 PRO- <br />JECT LOC <br />E Ban . <br />1,000,000 <br /> AU T <br />OMOBILE LIASILITY <br /> <br />INGLELIMrr <br />E <br />M <br />k <br />I <br /> <br />000 <br />000 <br />151 <br />A X ANYAU70 2068975084 02/01/10 02/01/11 <br />aac <br />( <br />ar <br />I <br />l <br />a <br />, <br />, <br /> ALL DINNED AUTOS BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per Perso^) ( 5 <br /> X HIRED AUTOS t7ROVE " AS TO FORK, (BODILY 94JURY s <br /> X NON-OWNED AUTOS ! (Perr,tcldeM) j <br /> <br /> E- ? PROPERTYOAMAGE <br /> I 3 <br /> <br /> GARAGE UASKJY Laur St:tt Sneed AUTO ONLY - EA ACCIDENT S <br /> ANY AUTO i1.i5ISt8 t. City Atto 7 • OTHER THAN EA ACC 3 <br /> . AUTO ONLY- AGG 3 <br /> EXCESS J UMBRELLA LWCLLIrY j EACH OCCURRENCE ' 55,000,000 <br />A X OCCUR CLAIMS MADE 20689753444 02/01/10 02/01/11 AGGREGATE s <br /> s <br /> DEDucneLE 1 3 <br /> X ( RETEN ION so <br />S <br /> WORKERS COMPENSATION <br />A U- M ' <br /> AND EMPLOYQtS'LWBILJTY YIN TORY LINTS ER ! <br /> <br />ANY PROPRIETOWPARTNFRIEXECU <br />OFFICERIMEMBEREXCLUDED? <br />E.L, EACH ACCIDENT --•, <br />S <br /> _ <br />(Maadat0ry14NH) <br />f <br />describe order <br />ec <br />EL DISEASE-EAEMPlOYE <br />3 <br /> y <br />. <br />SPEGIALPROVISIONSb <br />k <br /> i: <br />m E.L. DISEASE- P0 <br /> <br />OTHER _ <br />H Professional EEA276170923 02/01110 02/01/11 Claim/Agg 3,000,000 <br />Liability (EEO) Deduct. 100,000 <br />OESGRIPTTON OF OPERATION I LOCATIONS 1 VEH=Ea I EXCLUSIONS ADDED BY ENDORGEMEN71 SPECIAL- PROVISIONS <br />Certificate Holder is additional insured as respects to General Liability <br />per attached G-17957-G99. <br />*Supercedes and Replaces certificate issued 2-1-10*** <br />*The CANCELLATION notice herein is amended to read 10 Days as respects any <br />cancellation due to non-payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Dept of-7RUhli _. g or.It.5 <br />220 S. Ze <br />Santa Ana CA 92703 <br />ACORD 25 (2009101) <br />SHOULD ANY OF THE ABOVE DESCMBEO POLICIES 13E CANCELLED BEFORE THE EXPIRATION <br />SANSANP, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY FOND UPON THE INSURER ITS AGENTS OR <br />REPRESENTATIVES, <br />fhe ACORD name and logo are registered marks of ACORD <br /> <br />( <br />I