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A� ID CERTIFICATE OF LIABILITY INSURANCE <br />DDIYYY <br />DAr2113/2018 YI <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSNORIGHTS 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(les) 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 <br />CIBC Insurance Services LLC <br />License#OK19767 <br />32 Old Slip <br />CONTACT <br />NAME: Carrie Clark <br />PHONE 310-981-0801 FAX <br />nooaless: carrie.clark@crystaloo.com <br />New York NY 10005 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Hartford Underwriters Insurance Company <br />30104 <br />2/1/2019 <br />INSURED CLNLA <br />Clinical Laboratory of San Bernardino, Inc. <br />P.O <br />P.O Box 329 <br />INSURER B: Transportation Insurance Company <br />20494 <br />IN Continental Casualty Company <br />20443 <br />INSURER D: Hartford Accident and Indemnity Company <br />22357 <br />San Bernardino CA 92402 <br />INSURER E : <br />MED EXP (Any one person) $ 5,000 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 502710517 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 />INTR <br />TYPE OF INSURANCE <br />AODL <br />SUBR <br />POLICY NUMBER <br />POLICY SEE <br />Mnncuc YW <br />LIMITS <br />B <br />X COMMERCIAL GENERAL LI ABILITY <br />V <br />Y <br />5068208188 <br />2/1/2016 <br />2/1/2019 <br />EACH OCCURRENCE $1,000,000 <br />CLAIMS -MADE � OCCUR <br />ETO S(Ea .TED <br />PREMISES RENT rrence)$100,000 <br />PREMISES <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL &ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE $2,000,000 <br />POLICY PRO- LOC <br />ECT <br />PRODUCTS -COMPIOPAGG $2,000,000 <br />$ <br />OTHER: <br />D <br />AUTOMOBILE <br />LIABILITY <br />1OUECHF6015 <br />2/1/2018 <br />2/112019 <br />COMBINED SINGLE LIMIT <br />Ea aadid.,t $1,000 000 <br />BODILY INJURY (Per person) $ <br />X <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE $ <br />Per accident <br />B <br />X <br />UMBRELLA LAB <br />OCCUR <br />6046009225 <br />2/1/2018 <br />21112019 <br />EACH OCCURRENCE $5,000,000 <br />AGGREGATE 1 $5,000,000 <br />EXCESS ILIAD <br />CLAIMS -MADE <br />DED X I RETENTION$ lL tne <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />10WECAS&498 <br />21112018 <br />2/1/2019 <br />X PER BTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $1,000,000 <br />PPRJETO REX TNER/E ECUTIVE F7Y <br />OFFICERIMEMI <br />NIA <br />E.L. DISEASE - EA EMPLOYEE $1000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $1000,000 <br />C <br />Professional Liability and <br />EEH276170923 <br />2/l/2017--7 <br />Each Claim/Aggregate 3,000,000 <br />Pollution Incident Liability <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: Consultant Agreement Extension. <br />City of Santa Ana, it's officers, employees, agents and representative are included as additional insured as required by written contract with the named insured <br />as respects General Liability coverage per the terms and conditions Of the policy. Waiver of subrogation applies in favor of the certificate holder per the terms <br />and conditions Of the policy. 30 Day Notice of cancellation is granted in favor of the certificate holder. <br />Z// 3//5 , PVCe, 7 <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016/03) <br />© 1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />144- <br />1✓ <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 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Agency <br />20 Civic Center Plaza M-36 <br />AUTHORIZED REPRESENTATIVE <br />P.O. Box 1988 M-36 <br />Santa Ana, CA 92702 <br />CX Le, <br />ACORD 25 (2016/03) <br />© 1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />144- <br />1✓ <br />