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AbF CERTIFICATE OF LIABILITY INSURANCE
<br />DDIYYYY)
<br />D (MMIRH
<br />313 ATE TE (MMI
<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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). ....Pabla
<br />PRODUCER
<br />Crystal & Company #01<1 9767
<br />CIBC Insurance Services LLC
<br />601 S. Figueroa Street, Suite 4480
<br />CONTACT
<br />NAME: BarroS
<br />PHONE 310.981.0820 FAX
<br />E -MAIL pabla barros@ crystalco.com
<br />Arl ss _....__
<br />INSURER'S AFFORDING COVERAGE
<br />NAIL #
<br />LOS Angeles CA 90017
<br />INSURER A:Transportation Insurance Company
<br />20494
<br />INSURED CLINLA.
<br />INSURER B:Hartford Underwriters Insurance Com
<br />30104
<br />Clinical Laboratory of San Bernardino, Inc.
<br />INSURER C :Continental Casualty Company _..._._..._
<br />Q43...m_.__
<br />P.O Box 329
<br />MED EXP (Any ore person)
<br />_.._...
<br />San Bernardino CA 92402
<br />INSURER D
<br />INSURER E:
<br />INSURER F
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />COVERAGES
<br />CERTIFICATE NUMBER: 1561090687
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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 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 />.., ........ ..__...........
<br />INSR TYPE OF INSU RA.NCE POLICY EFF POLICY EXP LIMITS
<br />LTR INSD WVD POLICY NUMBER MMIDDfYYYY MMIDDIYYYY
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />5088208188
<br />2/112016
<br />2/1/2017
<br />EACH OCCURRENCE
<br />$1,..000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence._
<br />$100,000._......,.__......._
<br />MED EXP (Any ore person)
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />�. POLICY [E JE® F—] LOC
<br />PRODUCTS, COMPIOPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />5488248224
<br />2/1/2016
<br />21112017
<br />E2 accident IN L I. '.,I.
<br />$1,044,044
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />AUTOS NED SCHE ULED
<br />.........--_..._........
<br />BODILY INJURY (Per accident)
<br />$
<br />Ix
<br />NON - OWNED
<br />HIRED AUTOS AUTOS
<br />.._bA_...A. _E7_..._
<br />PerlaEid'entDAMAGE
<br />$
<br />$
<br />A
<br />X
<br />UMBRELLA LIAR X OCCUR
<br />5088248269
<br />2/112016
<br />2!1/2017
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LAB CLAIMS -MADE
<br />DED I X � RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIABILITY' YIN
<br />10WECAN1623
<br />21112016
<br />2/1'/2017
<br />PER 0 IT,
<br />x_ STATUTE .._..._ ..ui ,_
<br />_
<br />ANY PROPRIETORJPARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICERIMEMBER EXCLUDED? El
<br />N/A
<br />IMandatory In NH)
<br />E.L. DISEASE- EA EMPLOYE..
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E1, DISEASE - POLICY LIMIT
<br />$1,000,000
<br />C
<br />Environmental Professiona@ Liab
<br />Claims Made Coverage
<br />EEH276170923
<br />2/1/2416
<br />2/112017
<br />$3,004,000 Per Claim $3,000,000 Agg 7
<br />Deductible; $100,400
<br />DESCRIPTION OF OPERATIONS I1LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, it's officers, employees, agents and representative are included as additional insured as respects to General Liability per
<br />attached form #G1 7957H & G134802.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS..
<br />220 S. daisy Avenue
<br />Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE
<br />C) 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />-4, ..
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