|
ACC>R'R"r CERTIFICATE OF
<br />DATE(MMIOOIYVYY)
<br />LIABILITY INSURANCE
<br />01/31/2014
<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 SY THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE OCES 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 pohcy(los) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may requlre an endorsement. A statement on this cerilHpals does not confer rights to the
<br />certificate holder In Ilau of sueh endorsement(s).
<br />PRODUCER 1.909- 243 -8200
<br />CO
<br />NAME:
<br />Nays of California Ii1KUrantle services - pntaric
<br />P�pH�OyE
<br />§M) „909243 -8200 INC.N.1 908.24,3 8201
<br />Empire ra IV
<br />3800
<br />E.MbfLn
<br />..3091!ESa —_.
<br />'— -”
<br />pane nooU Curd, Suite 3400
<br />Ontario, CA 91764
<br />Pri0E1pGER
<br />GU6T4MLR 12N :- _....._._ .................... ........... ... ... _... _.__.
<br />Kelly Petersen - _ _
<br />_ INSURER L6I APFOROING OOVERAGE, MAICB
<br />INSURED
<br />INSURERA: IRANSPORTATZON INS CO 20944
<br />Clinical Laboratories OE San Bernardino, Inc.
<br />INSURERA: HARTFORD GTR& IN CO '19682
<br />P.O. Box 329
<br />_
<br />INSURERC CONTXNENTAL CAS CO _ .20441
<br />San Bernardino, CA 92402
<br />INS"Reer- ?L.... -"
<br />x ,I I'
<br />HIREDAU Q$ �..���
<br />INSURER E1.:
<br />y �ry
<br />NONANINEO ADTOe
<br />INSURER K
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY RERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
<br />OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 9UBJEC'r TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />IN9Rr _..._ .... SUek ... ... ... .. ...�..__� ......,.
<br />L TYPI OP INSURANCE POLICY S%'F '
<br />POLICYNI ER
<br />_.- ..,._., ...
<br />-P 41OY A %P " "' "......... " "'
<br />nM LIMITS
<br />A OF,NERAL LIABILITY IC 4034939429 !i 02/01/1
<br />_ -.._.
<br />02 /DS /l8I EALH dI CIIRRENGG '41,000,000
<br />I
<br />X COMMERCIAL GENERAL LIABILITY
<br />"OAMaoETORENTeb •.._.. .... .'.....'.
<br />.pgrhll$.GA lEg "Renu,J'GV $ 104 00p
<br />_EJ CLAJM6 MADE X!bCCUR
<br />MED EXP IAT, One perepn) 610, 0D0
<br />— _—
<br />PERapNAL a NOY INJURY -5 I. D00,000
<br />_
<br />IGENERAL AGGIaEOFlTE g2 000,000
<br />...... _.. _
<br />GThN'L At"iGRHGATE LIMIT AP
<br />.. - PLIES PER:
<br />I
<br />' PPOQUOT @•CQNIPlOP AOG I 000
<br />`
<br />PaLICY PRO.
<br />TOT LOC
<br />- -x000 ...... ..
<br />B
<br />A AUTOMOBILE LIABILITY 'C 40349393 02 0
<br />A
<br />41 i5; CQMHINEO BINDLE LIMITS 1r O0tl, pOq
<br />i. (Ea SupMNn1).
<br />?�... ANY AUTO • ["a
<br />!I
<br />SWAY INJURY
<br />R'iV
<br />ALL OWNED AUTOS I
<br />: IPar parson) b
<br />- — - -
<br />BODILY
<br />SCHILOLLEDAUTO5
<br />INJURY IFler aor tlent) &
<br />x ,I I'
<br />HIREDAU Q$ �..���
<br />(PRgPCRTY pAMAOC S
<br />, PtlY wU9un0
<br />y �ry
<br />NONANINEO ADTOe
<br />IE
<br />A 'X - UMBflELLAL1Aa OCCUR :CUP4034939 02/01/14
<br />02/01/15 EACH OCCURRENCE $ 5,000,000
<br />•.... .. ".
<br />EXCESS LIAR CLAIhtA•MACEI
<br />��....____. ...... ...
<br />._.� -.
<br />GGREGAD 55 000,000 _.
<br />A .,....... ._.... .... . ..
<br />"_I OEtlUCTIULk
<br />..
<br />';
<br />X I RETENTROB 0
<br />5
<br />H a OONIPEI A 41 02 /Og�yq
<br />WEC BR0213
<br />_
<br />� f,brATU" OTi
<br />AND EMPLOYERS'LI ABILIT V
<br />—f11,
<br />TORY.4IMB'.9.1 ER ...
<br />ANY PROPEMBE Ir4•.
<br />I G,L EACH ACCIDENT $1.,000,000
<br />SNOLUDED[cuTlVe
<br />OFFnO@PoMEM5ER F_NOLUOEC? iNIAI
<br />(MandalarY In Nhq -
<br />-.__-
<br />- 1 ..
<br />6 1,000,000
<br />yy
<br />' IpESCRIPPION OF OPERATIONS below
<br />BL, O SEASE. POLICY LIMITED' $ 1, 000, 000
<br />C Bro ads ono y -' IEEH27 61790 laimp iqa a 02
<br />15 3, , Be 1 ,
<br />DESCRIPTION OF OPSATIONal LDOATIDN9I VEHICLEA AIInaN ADDRD IUl, A0.tliliannt Ramarke Schbdu ,I mare epeae lx
<br />rngldrl ('� '
<br />Certificate Nolder is named as additional insured an respects
<br />General Liability gar form Q -17957 -099 ati:ached.
<br />10 day Danoellation for non payment of premium.
<br />City of Santa A.G. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Dept e£ Pub11e works THE WITH THE POLICY PROVINiONS,
<br />220 S, Betsey Avenue
<br />AUTHORIZED REPRE"N'I'ATIVB
<br />Santa Ana, CA 92703
<br />USA
<br />ACampos d 1988.2009 ACORD CORPORATION. All rights roaerved,
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|