CLINICAL LABORATORY OF SAN BERNARDINO 12 - 2010

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A- L.010•0-716 RO® CERTIFICATE OF LIABILITY INSURANCE OP ID DO DATE(MWDDNYYY) CLINI-1 02/01/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Andreini & Company-South Coast ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One MacArthur Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Coast Metro CA 92707 Phone:714-327-1400 Fax:714-327-1499 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Coatiaeatal Casualty Company 20443 INSURER B: Transportation Insurance Co. 20494 Clinical Laboratories of San Bernardino, Inc. INSURER C: P.O. Box 329 S B di CA 92402 INSURER D: an ernar no INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IM LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY DATE MMID EFFECTIVE DIYYYY) POLICY EXPIRATION DATE (MWDDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY _ 2068975201 02/01/11 02/01/12 P ISES Eaoccurence $100,000 CLAIMS MADE Fx 1OCCUR MED EXP (Any one person) $10,000 PERSONAL dADVINJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: - PRODUCTS - COMP/OP AGG $ Exc luded X POLICY 1 1 jzn LOC Em Ben. 1,000,000 AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $1 000 000 $ X ANY AUTO 2068975084 02/01/11 02/01/12 (Ea accident) , , ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Peraccident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY - FA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ H AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000 B X OCCUR EICLAIMSMADE 20689753444 02/01/11 02/01/12 AGGREGATE $ n A P $ . P R_U V ED '-1 €€ ? DEDUCTIBLE L, 1-OR S X RETENTION so _. , S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ..` ` L "'" ? TORY LIMITS II ER Y I N •1+? - .L,? ,>° t' ? ANY PROPRIETORIPARTNERIEXECUTNTF] OFFICERIMEMBER EXC DE ? E.L. EACH ACCIDENT $ D LU (Mandatory In NH) ; ? i ? l i t E.L. DISEASE • EA EMPLOYEE S If yes, describe under . . t l y _ . ((U F t1 t % SPECIAL PROVISIONS below } E.L. DISEASE - POLICY LIMIT $ OTHER A Professional EEA276170923 02/01/11 02/01/12 Claim/Agg 3,000,000 Liability (E&O) Deduct. 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Certificate Holder is included as additional insured as respects to General Liability per attached G-17957-G99. *The CANCELLATION notice herein is amended to read 10 Days as respects any cancellation due to non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO SANSANE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILIIFY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Santa Ana Dept of Public Works REPRESENTATIVES. 220 S. Daisey Ave ' AUTHOR EPRESENTATNE ACORD 2512009/01) ©1988-2009 ACCFRD CORPORATION- All rlahts reserved. The ACORD name and logo are registered marks of ACORD