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<br />Ac R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDMYW)
<br />3/30/2016
<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 pohcy(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).
<br />PRODUCER
<br />Cryystal & Company #OKI9767
<br />CI BC Insurance Services LLC
<br />CANT." Pabla_Barros
<br />PHONE 310 -981 -0920 Fnx
<br />'- Ewu -_-°—
<br />601 S. Figueroa Street, Suite 4460
<br />E-MAIL pabla barros c stalco.com
<br />ADOSesa.___.._:_..__ ry -- - - --
<br />INSURERMI AFFORDING COVERAGE
<br />NAI'C p
<br />LOs Angeles CA 90017
<br />INSURER ATTrans ortation Insurance Come.,., ......
<br />20494 .......
<br />EgCH OCCURRENCE
<br />INSURED CLINLA
<br />INSURER a:Hartford Underwriters Insurance Com
<br />30144 -
<br />INSURER C:Continental Casualty Company
<br />20443
<br />Clinical Laboratory of San Bernardino, Inc-
<br />INSURER 0:
<br />P.0 BOX 329
<br />San Bernardino CA 92402
<br />PREMISE E =Lrne.ral
<br />$100,000
<br />INSURER E
<br />$10,000
<br />INSURER P
<br />V0:011,11E�RCIIALIIENERAL
<br />COVERAGES CERTIFICATE N' MBER' 1561096687 REVISION N BER:
<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
<br />LTR
<br />_�._,�...__�— ____._..
<br />TYPE OF INSURANCE
<br />A4S
<br />INSD
<br />WVD
<br />—_` —_
<br />POLICY NVMaER
<br />POLICY EFF
<br />mmfoo /YY
<br />POLICY EXP
<br />M11M10D
<br />LIMITS
<br />A
<br />LIABILITY
<br />50882081$8
<br />2/'11201$
<br />2!7/20'17
<br />EgCH OCCURRENCE
<br />$1CL
<br />IM OCCUR
<br />PREMISE E =Lrne.ral
<br />$100,000
<br />MELD EXP(Any one person)
<br />$10,000
<br />V0:011,11E�RCIIALIIENERAL
<br />PERSONAL &AOV INJURY
<br />$1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />GENERALAGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMPIOP AGE
<br />$2,000,000
<br />X POLICY PRO D LOC
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />508$208224
<br />21112016
<br />211/2017
<br />COMBINED 6 LIMIT
<br />$1,000,000
<br />BODILY INIU Par person)
<br />$
<br />X ANYAUTO
<br />BODILY INdl1RV (Per acddenl}
<br />3
<br />X ALL OWNED SCLIEOULED
<br />AUTOS AUTOS
<br />A N-OWNED
<br />X HIREDAUTDS AUTOS
<br />PROPERTY -DA�I WGEv- - - -
<br />Per accident)__ „ - „_ _
<br />-_^
<br />$
<br />$
<br />--
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />5088208269
<br />2)112016
<br />2/112017
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAR
<br />CLAIMS-MADE
<br />DED I 'X I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETONPARTNEWEXECUTIVE YYtN
<br />IOVOEOAN1623
<br />21112016
<br />214/2017
<br />X I PER OTH
<br />STATUT_ ” ""'
<br />'
<br />E.L EACH ACCIDENT
<br />$1,000,000
<br />E.L, DISEASE- EA EMPLOYE-
<br />$1,000,000
<br />OFFICENMEMBER EXCLUDED?
<br />(Mandatary N NHI
<br />E.L DISEASE - POLICY LIMIT
<br />1 $1,000,000
<br />IF yes, despdbe under
<br />DESCRIPUONOF OPERATIONSbelaw
<br />0
<br />Environmental Professional Uab
<br />EEF1276170923
<br />2/1/2016
<br />21#2017
<br />$3,000,000 Per Claim $3,000,000 Agg
<br />Claims Made Coverage
<br />Deductible; $100,000
<br />DESCRIPnON OF OPERATIONS I,LOCATIONS I VEHICLES (ACORD 101, Addltlanal Ramarks Schedule, may be anachad ri maro space Is regolretl)
<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 #G17957H & G1 34802C.
<br />City of Santa Ana
<br />220 S. Daisy Avenue
<br />Santa Ana, CA 92703
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />(.I9...Fai'rRN Y GA`I)!Pr'�'M.M' <) -. M/ M.{Mraau.[J. r.^” "•�•+°J•^"A.t.yr''
<br />All rights reserved.
<br />ACORD 25 (2014)01) The ACORD name and logo are registered marks of ACORD
<br />2SE930
<br />
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