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ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDII'YYY) <br />Te 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: If the certl eats holder la an ADDITIONAL INSURED, the polley(les) must be endorsed. If?3UBROGATION IS WAIVED, subject to <br />the farms and condltlons of the policy, certain policies may raqulre an endorsement. A statement on this eertlfleate does not confer rights to the <br />ceRlflcata holder in Ilau of such andoreement(s). - <br />PROnucER <br />NAME: <br />Physicians Risk Associates Insurance Agency acNeE:t: 800.910.6535 n/CNe:949.305_6166 <br />26691 Plaza Drive, Suite 220 AoDREas: <br />rriSSiOn V7ej0, CA 92691 INBURERI9IAFFORDIN000VERAGE NAICf <br />INSURERA: EVanstOn <br />INSURED California Laboratory Sciences, LLC INSURER B: <br />10200 Pioneer Blvd INSURERC: <br />Suite 500 wsuRER D <br />Santa Fe Springs, CA 90670 INSURERE: <br />INSURER F <br />RrfVfFRAf?FR CFCTIFII_ATF IJIIMriGO• Prr.F 1 iah DC1/In1/llV u,lu?CO- <br />THIS IS TO CERTIFY THAT THE POLICIES OF IN URANCE LISTED 8EL W HAVE BEEN ISSUED TO THE INSURED AMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 INSR WVD POLICY NUMBER MM/DD/Y`/W MM/DD/YWY LIMITS <br /> GENERAL LIABIDTY EACH OCCURRENCE 3 <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea nmurenm S <br /> CLPJMS-MADE ? OCCUR MEO OCP (Any one person) $ <br /> PERSONAL b ADV IWURV $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE OMIT APPLIES PER: PROOLICTS -COMP/OP AOG $ <br /> POLICY JEpo-T LOC pp $ <br /> AUT OMOBILE LIABILITY ? E:9 acrJtlen $ <br /> ANY gUTO BODILY INJVRY (Per person) $ <br /> ALL OWNED <br />AUT03 SCHEDl1LE0 <br />AUTOS BOd LY INJURY (Pere rltlent) $ <br /> HIRED AUTOS AN?OOSWNED par eaitlan[ $ <br /> CRAS'THWAITE $ <br /> UMBRELLA LIAR OCCUR ? EACH OCCURRENCE $ <br /> EXCEBS LVaB CLAIMS-MADE AGGREGATE $ <br /> OEa RETENfION$ ? i <br /> WO <br />AND RKERS COMPENBATON <br />EMPLOYERS' LIABILITY <br />TORY LIMITS ER ' <br /> ?./ N <br />ANY PROPRIETOR/PARTNER/FJ(ECUTI <br />? <br />N / A EL EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUOED9 <br />(MSndetory In NH] E.L. DISEASE- EA EMPLOYEE $ <br /> 1/yes tlasviba antler <br />DESCRiPT10N OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br /> <br />A ro essiona L a T Tty <br />eductible: $5,000 SM87656 <br />? 12/03/2010 <br />- 12/03/2011 $1,000,000 Per Claim <br />$3,000,000 Aggregate <br />DESCRIPTION OP OPERATONS / LOCATONS /VEHICLES (Altxl, ACORD 101, Additional Remarks 9cbatlule, if moro specs le npulred) <br />O Days Notice of cancellation, 10 days for non-payment of premium? <br />omplete named insured is California Laboratory Sciences, LLC, DBA: West Pacific Medical Laboratory; <br />est Pacific Medical Laboratory, LLC; AD] Corporation. <br />(4CK L IF IIiAI C MVLUCK lSA1Yl1CLLA 1 IVIY <br /> <br />- 6HOULD ANY OF THE ABOVE OEBCRIBEO PODCIES BE CANCELLED BEFORE <br /> THE EXPoRATON DATE THEREOF, NOTICE WILL BE DELNERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />Attn: Fire Department AVTH DREPRESENTATVE-----_ --_--,-_ <br />? <br />20 Civic Center Plaza ??- <br />Santa Ana, CA 92701 <br />® 19H8-2010 ACORD CORPORATION- All righte reserved <br />ACORD 26 (2010/06) The ACORD name and logo era registered marks of ACORD