CALIFORNIA FORENSIC PHLEBOTOMY-2017

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CALIFOR-01 RROYC (MMID,a►coRU' DA12111/2 Y017 21117 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # 0596796 CONTACT NAME Fullerton Insurance Service, Inc. P.O. BOX 4054 Fullerton, CA 92834-4054 A- Z.o (, - 33 7 PHONE FAX AIc, No, El): (714) 577-5800 A/C, No : 714 447-0011 E-MAIL , rec@fullertoninsurance.com INSURERS AFFORDING COVERAGE NAIC IF INSURER A, Evanston Insurance Co. 35378 INSURED INSURER B:Midwest Employers Casual Co. 2 612 INSURER C: California Forensic Phlebotomy Inc. INSURER D 27762 Antonio Pkwy, Ste Li-647 Ladera Ranch, CA 92694 INSURER E INSURER F: rnVPRAr:F1R CERTIFICATE IdHMRFR• RFVISION NUMRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X I COMMERCIAL GENERAL LIABILMY CLAIMS -MADE �X OCCUR Prof Liab- Claims Me X SM922977 11/1712017 11117/2018 EACH OCCURRENCE 2,000,000 DR AGETOEMISESERENTEonOQ.ur 90,000 X MED EXP (my onePerson) 5,()00 PERSONAL &ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRC LOG OTHER: GENERAL AGGREGATE 3,000,000 PRODUCTS - COMP/OP AGG 1,000,000 PROF LIAB AGG 3,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTEO�S ONLYNAUTOS Ep X AUTOS ONLY WPM SM922977 11/17/2017 1111712018 COMBINED SINGLE LIMIT (Ea accident)$ 1,0 =0 0 BODILY INJURY PerPerson) $ BODILY INJURY Per accident $ PerOacc Eant AMAGE $ ++- UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS.MADE EACH OCCURRENCE $ AGGREGATE DED RETENTIONS B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V� QAQN�V PROPRIETOR/ EXCLUDED? plandatory 1. NN) EXCLUDED? WH es,de%dbe Under D CR PT N ERATIONS below NIA BNUWC0138098 10/01/2017 10101/2018 X I PERTUT I I ETRH- E.L. EACH ACCIDENT 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DIS E-POL CV LIMIT 11000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached If more space is required) City of Santa Ana, its officers, employees, agents, volunteers and representatives are Included as additional insureds. Coverage is primary and n contributory. y Santa Ana Police Department I Chiefs Office Leo Martinez M-97 60 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD