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ACORO?, CERTIFICATE OF LIABILITY INSURANCE I DATE(LtM/DD/YYYYI <br />11/01/2011 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: IT the certifleate holder Is an ADDITI NAL INSURED, the pollcy(las) must be endorsed. If SUBROGATION IS AI ED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certlflcate does not confer rights to the <br />cartlflcate holder In Ileu oP such endorsement(s). <br />PRODUCER {:VNlwcl <br />NAME: <br />Physicians Risk Associates Insurance Agency ac Ne E,n: 800.910.6535 ,,,/c Ne;949.305.6166 <br />26691 Plaza Drive, Suite 220 ADDRESS: <br />M75570n Viejo, CA 92691 INSURER(S)AFFORDING COVERAGE NAICN <br />INSURERA: CNA Insurance <br />INSURED California Laboratory Sciences, LLC INSURERS: Travelers Insurance <br />DSA: West Pacific Medical Laboratory INSURERC: <br />West Pacific Medical Laboratory, LLC INSURERD: <br />10200 Pioneer Blvd. Suite 500 INSVRERE: <br />Santa Fe Springs, CA 90670 INSURERF: <br />COVE RO[3FC f_FRTIFIr_ATF r,1111N RFR• RAP ocv,C,AU uI IMOCO. <br />THIS IS TO. CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO VE BEEN ISSVED T THE INSURED NAMED A R THE POLICY PERT D <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR TYPE OF INSURANCE 1NSR WVD POLICY NVMBER MM/DD/YYYY MMIDpYYYY LIMITS <br /> GENERAL LIABILITY 4024175172 10/01/2011 10/01/2012 EACH OCCURRENCE s 1,000,000 <br /> X COMMERCIAL GENERAL UABILT! PREMISES Ee oca,nence S 3OO.000 <br /> CWMS-MADE ?X OCCUR MEO EXP (My one person) $ 10 OO <br />A PERSONAL 6 ADV INJURY S 1 , OOO , OOO <br /> GENERAL AGGREGATE S 2 OOO OOO <br /> GENE AGGREGATE LIMIT APPLIES PER PRODUCTS - GOMP/OP AGO S 2 , OOO OOO <br /> POLICY JECOT LOC _q ?V? <br />A? a V $ <br /> AUT OMOBILE LIAHILnY r $ 3792 11!'16/2010 11/16/20'1'1 ??? $ 1 000,000 <br /> ANY A1.1T0 ? BODILY INJURY (Par parson) S <br />B ALL OWNED <br />AUTOS SCHEDULED <br />AUT09 BODILY INJURY (PSr eocitlenQ S <br /> <br />X <br />HIRED AUT03 <br />X NONA <br />AUTOS ? <br />Per aoGOent <br />$ <br /> W $ <br /> UMBRELLA LIAa OCCUR OZ4190S1 10/01/2011 10/01/2012 EACH OCCURRENCE $ 2,000 OOO <br />A EJ(CESSLIAB CLAIMS-I.MDE UMBRELLA LIAB. AGGREGATE $ 2,000,000 <br /> DED RETENTON$ SO • OO $ <br /> WO <br />AND RKERS COMPENSATON <br />EMPLOYERS' LIABILITY <br />TORY LIMITS ER <br /> ECUTIVC(? <br />OFF <br />E <br />B <br />/ N / A E.L. FACH ACGDENi $ <br /> MEM <br />IC <br />R <br />ER EXCLUDEDY <br />(Mantlatory In NN) u ? E.L. aSEASE - EA EMPLOYEE $ <br /> h describe Imder <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br /> <br />A an et Bus nass Prop <br />pec.Form Rep.Cost 4024175172 10/01/2011 10/01/2012 $2,614,980 Blanket Limit <br /> <br />$5,000 Deductible <br />DESCRIPTON OF OPERATONS / LOCATONS /VEHICLES (Attach ACORD t07, Addltlonsl Remerlu Sc1,sWrls, If more spats Is rsQulrad) <br />30 Days Notice of cancellation, 10 days for non-payment of premium. <br />he City of Santa Ana, its officers, agents, volunteers and employees are named as Additional Insured <br />or General Auto and Umbrella Liability only. General Liability is written on a primary and non- <br />ontributory basis. <br />GCKI lr•IGAIC HVLVCK GANGCLLAIIVN <br />SHOVED ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />TIE EXPIRATON DATE TFIEREOF, NOTCE'WILL BE DELIVERED IN <br />ACCORDANCE WITH TIE POLICY PROVISIONS. <br />City of Santa Ana <br />Attn: Fire Department <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />cFl l9Gtl-"L090 AGGRO CORPORATION. All ngnts rea0 <br />ACORD 26 (20'10/OS) The ACORD name and logo are red marks of ACORD