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CALIFOR-01 LARRO
<br />ACORD DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 10/01/2018
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 0596796 CONTACT
<br />NAME:
<br />Fullerton Insurance Service, Inc. PHONE FAX
<br />P.O. Box 4054 (AIC, No, Ext): (714) 577-5800 (A/C, No):(714) 447-0011
<br />Fullerton, CA 92834-4054 E-MAIL, �. rec(a�futlertoninsurance.com
<br />INSURED
<br />California Forensic Phlebotomy Inc.
<br />27762 Antonio Pkwy, Ste L1-647
<br />Ladera Ranch, CA 92694
<br />StarN
<br />Insurance
<br />COVERAGES CFRTIFICATF NI IMRFR• owicrnu u1 1■.—r,-
<br />- - - -- F-VY IVIM 1NU1V10Crt.
<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 />INSR ER TYPE OF INSURANCE ADDL SUM POLICY EFF POLICY EXP
<br />LTR INSD WVD POLICY NUMBER MMIDDNYYYI (MM/DDNYYYI LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I A I OCCUR
<br />Prof Liab- Claims Ma
<br />X
<br />SM922977
<br />11/17/2017
<br />11/17/2018
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />PRAEMISEs eaoccu ante
<br />$ 50,000
<br />X
<br />MED EXP (Any oneperson)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECOT- El LOC
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000,000
<br />A
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />PROF LIAB AGG
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 3,000,000
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X AUTOS ONLY X AUOTOS ONLY
<br />SM922977
<br />11/17/2017
<br />11/17/2018
<br />BODILY INJURY Per accident
<br />$
<br />P O.PE dentDAMAGE
<br />$
<br />UMBRELLA LIAB
<br />HAGGREGATE
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />_
<br />X STATUTE ERH
<br />$
<br />B
<br />N/A
<br />BNUWC0138098
<br />10/01/2018
<br />10/01/2019
<br />EI_FACHACCIDENT
<br />$ 1000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds. Coverage is primary and non
<br />contributory.
<br />� pp�'' ,,, i ��!/!J M) lia 11,0 /':3�r 4r
<br />Santa Ana Police Department / Chiefs Office Leo Martinez
<br />M-97
<br />60 Civic Center Plaza
<br />Santa Ana, CA 92702
<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 />FIVVRV LA ILu loruol U 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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