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Home My WebLink AboutCLINICAL LABORATORY OF SAN BERNARDINO 2 - 2003 , . /h;{OO3- AB9-{)J INSURANCE ON FILE WORK MAY PROCEEO UNTIL INSURANCE EXPIRES 7-- I ~O~ CLERK OF COUNCIL DATE: I.) - 1'/ -D5 0: PWYt (;>) Cr.P'J) FIRST AMENDMENT TO CONSULTANT AGREEMENT THIS FIRST AMENDMENT TO CONSULTANT AGREEMENT is entered into on December J ,2005, by and between Clinical Laboratory of San Bernardino, a California corporation ("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). RECITALS: A. The parties entered into a Agreement #A-2003-239, dated December 3 1,2003, (hereinafter "said Agreement") by which Consultant has provided domestic water quality testing. B. In accordance with the terms and conditions of said Agreement, the parties wish to renew said Agreement for an additional two-year period. WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this First Amendment to Consultant Agreement, the parties agree as follows: I. Section 2.a., COMPENSA nON, shall be amended to read, in full, as follows: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit B to said Agreement. The sum to be expended under said Agreement is $133,970.00, with a ten-percent (10%) contingency for a total amount which shall not exceed $147,370.00 during the two- year term from January 1,2006 through December 31, 2007." 2. Section 3, TERM, shall be amended to extend the term for an additional two-year period, through December 3 I, 2007. 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. , IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Consultant Agreement on the date and year first written above. CITY OF SANTA ANA ATTEST: ~~-~~ ~~"- / PATRICIA E. HEALY Clerk of the Council 'Ai 11~ ;/)/2~ DAVID N. REAM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney B J(- . ~I y: r\ -UM U" fU/ Laura .Sheedy l Assistant City Attorney CLINICAL LABABORA TORY OF SAN BERNARDINO r:?J/hwJ Jt:lur (NAME) ).A80AAWP-Y DHUft;;r~~ (Title) OP ID VJ DATE (MMlDDIYYYY) CLINI-1'&1 05/31/07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~CORD,. CERTIFICATE OF LIABILITY INSURANCE PRODUCER J Andreini & Company-South Coast License 0208825 One MacArthur Place, South Coast Metro CA Phone: 714-327-1400 -- .'_., , .- -, INSURED Suite 100 92707 ' !,a~~?14 ~327_~14!_9___ IINS.'-IRER~ AFFORDING ~OVE~GE '._. ~URER A. American Casual ty Company of A - ~C03 -~ ;;WRE; B -. Zeni th Insur~nce Company A ....1cC)j -.;lj9~~U!,ER~_='-==--=- ==-=-=-_ 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, "" ---."~- -~- POL'IC"y' NUMB-ER ~ ---I POLICY EFFECTIVE" rpQ[iCv EXPIRATION I TYPE OF INSURANCE ' DATE (MMIDDIYY DATE (MMIDDIYY) GENERAL LIABILITY I A X! X! COMMERCIAL GENERAL LIABILITY TCP2068975201 02/01/07 02/01/08 , ,. 'CLAIMS MADE [}c' OCCUR Clinical Laboratories of San Bernardino, Inc. P.O. Box 329 San Bernardino CA 92402 INSURER D 1-----'---, ,-- --- INSURER E: COVERAGES L TR INSR A I I l GEN'L AGGREGI\TE LIMIT APPLIES PER II Ix ! POLICY i j~c?T LOC ! AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X , NON.OWNED AUTOS BUA2068975084 02/01/07 02/01/08 GARAGE LIABILITY ANY AUTO A EXCESS/UMBRELLA LIABILITY X OCCUR I l CLAIMS MADE CUP20689753444 02/01/07 02/01/08 , DEDUCTIBLE RETENTION s10,OOO B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER F'XCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER C066924302 02/01/07 02/01/08 A Property Blanket 02/01/07 02/01/08 CERTIFICATE HOLDER CANCELLATION NAIC# 20427 I--=----=- LIMITS : EACH OCCURRENCE '~DAI\lI)l;GE I U Keo N I eo LJ -- P~MISESLEa occurence) ~~ED _E,XP (Anyone PersCln) PERSONAL & ADV INJURY ---- ---- --- -- GENERAL AGGREGATE r:RO~UCT~:_C~~~OP~GG Emp Ben. sl,OOO,OOO $100,000 s10,OOO s1,OOO,OOO 1$2,000,000 ~---- s Excluded ~---~,._._- 1,000,000 COMBINED SINGLE LIMIT (Ea aCCIdent) sl, 000, 000 BODIL Y INJURY (Per person) s BODIL Y INJURY {Per accldenU $ PROPERTY DAMAGE (Per aCCIdent) , $ , I AUTO ONL Y . EA ACCIDENT'S EA ACC r-S-- A-GG 1$ , OTHER THAN AUTO ONLY I EACH OCCURREN~E r f AGGREGAT~_ s5,OOO,OOO 1$-'-.'-- .f-- ---- i i 1-- ~ i TQR'y LIMITS ER IE L. EACH ACCID.ENT_. __ ~ 000 ! 000 EL.DiSEASE.I=AEMPLOYEE' $ 1, 000, 000 ~--- -- " E L. DISEASE. POLICY LIMIT S 1, 000 , 000 Property S ecial 1113000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE CITYSAA City of Santa Ana Department Of Public Works 220 S. Daisey Ave. Santa Ana CA 92703 ~~ ACORD 25 (2001/08) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 endorsement(s). DISCLAIMER The Certificate of insurance on the reverse side of this farm does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. f1i5 zf{ ACORD 25 (2001/08) ~AfA G-17957 -G99 (Ed. 10101) .. I '.. IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1. OF THIS ENDORSEMENT FOR THESE DUTIES. ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL LIABILITY COVERAGE WITH RESPECTS TO THE "BODIL Y INJURY" OR "PROPERTY DAMAGE" ARISING OUT OF THE "PRODUCTS-COMPLETED OPERATIONS HAZARD." SEE PARAGRAPH B.3. OF THIS ENDORSEMENT FOR THIS COVERAGE CHANGE. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH LIMITED PRODUCTS - COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project: Name of Person or Organization: gj "' ~ "' i ED ED l<l I ~ (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to Declarations of this policy, whichever is less. include as an insured any person or organization, These Limits of Insurance are inclusive of, and not including any person or organization shown in the in addition to, the Limits of Insurance shown in the schedule above, (called additional insured) whom you Declarations. are required to add as an additional insured on this 3. The coverage provided to the additional insured policy under a written contract or written agreement; by this endorsement and paragraph f. of the but the written contract or written agreement must be: definition of "insured contract" under 1. Currently in effect or becoming effective during the DEFINITIONS (Section V) do not apply to "bodily term of this policy; and injury" or "property damage" arising out of the "products-completed operations hazard" unless 2. Executed prior to the "bodily injury," "property required by the written contract or written damage," or "personal and advertiSing injury," agreement. When coverage does apply to "bodily B. The insurance provided to the additional insured is !,njuryd" or "proP1ertyd damage:' arisinhg oudt" of theh limited as follows: pro ucts-comp ete operations azar suc coverage will not apply beyond: 1. That person or organization is an additional insured solely for liability due to your negligence a. The period of time required by the written and specifically resulting from "your work" for the contract or written agreement; or additional insured which is the subject of the b. 5 years from the completion of "your work" on written contract or written agreement. No the project which is the subject of the written coverage applies to liability resulting from the sole contract or written agreement, negligence of the additional insured. whichever is less. 2. The Limits of Insurance applicable to the additional insured are those specified in the 4. The insurance provided to the additional insured written contract or written agreement or in the does not apply to "bodily injury,' "property -- ;;;; = - iiii - - - - == == = G-17957-G99 (Ed. 10/01) ~3/1 Page 1 of 2 damage," or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: B. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, or inspection activities performed as part of any related architectural or engineering activities. C. As respects the coverage provided under this endorsement, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to us for a loss we cover under this Coverage Part; (3) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (4) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: \.:l-1/l:Io/-l.:il:ll:i (Ed. 10101) 4. Other Insurance b. Excess Insurance This insurance is excess over any other Insurance naming the additional Insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. jS5 1/r G-17957 -G99 (Ed. 10/01) Page 2 of 2 I I I I I I I J ~ I r- I I I t ~ I .~: j- ~ I r h.; 1%.... .X-' -0. ~ J'i+ SEP-24-2007 MON 11:55 AM CLINICAL LAB OF S.B. -- .. . . - .. .~] ..~ .... ~.~ . FAX NO. 909 825 7696 P. 01 .f^- ~!~.u · I ~M b/~ -"' ......~..~ ....... -..-.--..--.-.---------.-.-......----.- PROFESSIONAL LIABILITY Z A - ~ 003 - & 3 C; - 0 I I INSURANCE COMPANY: Continental Casualty Company POLICY TERM: February 1, 2007 to February 1, 2008 PROFESSIONAL LIA~ILlTY . : - : '",,"- Gov ," of' , , ,'OS8 sUffeJtd'.': '. ". ' {whiCh Is,cover~:undQ,r( ':cl8ims..rna.:baal$~ ' limits of Insurance Each Claim Aggregate Deductible (Included Defense and Expenses Costs) $ 3,000,000 $ 3,000,000 $ 100,000 Claim Extension Period . From Cancelfation or Expiration if, the company cancels or non-renews: 12 Months @100%Annual Premium Included Retroactive Dates . Clinical laboratory , GEO Monitor Full Prior Acts Full Prior Acts Rating Basis . $2,795,594 Gross Sales Terms & Conditions: . Full Prior Acts Coverage . Coverage lor ADAlFHAlOSHA claims . Free Pre-claims Assistance ,. Circumstance Reporting Coverage . limited Contractual liability Coverage . Blanket Joint Venture . Mediation Deductible Credits . Defense Reimbursement Provisions . Personnel leased by You . Innocent Principals Coverage · Retired Consultant Personnel 178 " ^ ".) 1/3012007 16 J\,NJ>lUJI'I14t COMI'AI'I1f Ap~ 01 08 03:3Sp ,~~",... VI "'<. ,..." "llUlt:!lnl ,........0 A - dO<-'">:'$ - ;13'7 Public Works r-axlU btJO-J/8-4361 To Thamllt-;D A_.2oc:3.-.;:L3Q-bl A -;;;lC67- ~'t0 7146473345 p.2 Date: 4/112008 !1 13 AM Pag~ ... of 4 iiJ<;Lfl:<E" OP 10 N...I OATE (MMlOCllVY'r"Il CLINr-i'~ 04/01/00 THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONf'~"'" NO 'UGHT~ UPON THE CERTIFICATE: HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFOR.DED BY TloIE POI.ICIES BELOW. __ I l""~ _.. __. 1_20427 I -+ ~n"t~Mnt.~~ualt'f (!o.pl~ IJCQRD. CERTIFICATE OF LIABILITY INSURANCE PRODlJriOR Andreini & Company-south Coast L1cense 0208825 One ~cArthur Placo, Suite ~OO South Coa~t Met%o CA 92101 Phone:714-327-1400 Fax:714-321-1499 Clinical Laboratories of Snn Bernardino, Inc. P.O. Box ~2g San Bernardino CA 92402 -1-'NSURERS AFFORDING COVERAGE I' 'l~,. '~'" " '...... ....ulc.n r:uua.:'..:L c:~p,any 0 -'~")JRER F -. IN$<J~D 'i"~_"e); " ~I.'";, ~rr;: [ (,;OVf:RA,GES '>-~ c'. ~ L~" If '\!::'lR..\N(" J~,T1.._' ci~_'.',1i 1"."-"( c,':E.\' I,,::J.JF' , IL ;"'to Ir'.,_'~'~L ~.' ,'~. \i;.. l ,',-'f; Th>:: "~IU_ l f- ~I'. ',I' '~'A~:[; N,J, 'N1THS!Al'Llr,::; ilJ'.J' ~'r-r . 1'-~'II1:r(1 '"E....\1 ,,; :n.,~.'~";t.: J 1<(.,,' ,.(:,r<TFi.o" T I;fl '~'MtR O~..:U~I!:.",l '~' ~>-1 r,'Ei'-'f WH"."" :-:1'. "t~" t , 'IF :,'AY B= J::;SUtr (oR "",' >",0' I;'" 'H ;I'l'l!i'."'.".1 ~ff(:;:"DEC HI 1'-i I-'OL,OE:: ~1::::iC'1JHlCJ-.c-"'- ", L:.:, >i.'t" I,':' liE Itl'~1:"', u,.~II~,' ~'JI' CC'juIT,cr,~ 'JF ~l(, .',1 u,.""fJFL.',rF 1 ;',' I~ '*" <'1.'1'1 Iy:"" HN'F ~t.(:r-.' f'tULLU:C P- fl"'n ; ';',1'1'; , LT~N~ ~S1JAANCE I GENERALUABILlTY A i X X, r .,1,,,,] 1:::i;:"1 .-ft.j'i~'" I ....ql\ ~' t--I':lJ,lId" "1N)f' I_XJ 'iL ..,;f~ I-J .J BUA2068975084 1 ----1--- I ! ~\~~~5~~1: il]k~~ti~~m;'r{!,~N I 'LIMITS , - . --- -- I ~^CHO:~C.I~;/[~,'~L _ iL~.~~O :000'- '1:J,"\J','''~~FTErl 02/01/09 ,P:;F.MSES (ra X('r'~n~~) : j; 100; 000 G.~~'EXP'",'~':rn>~~'"'::~ k~D, coo'=- PFRS"I.jn,; ~ ~i)V 1'\,:1 ';:', 1 $ 1, 000,000 L'i :':~!-'J.; ACI1t(""TE : r 2 ,OOO~OOO' ,F,<,)[.L(;iS C'J'>'P;". ,.I.;'~ $ Exclud.ed 1----- J;;mp Ben. 1,000,000 U2/01/08 POL.1CYNUMBf-1l. TCA20609?5201 ,,;:N', ',,':~::j.'\l:: "''.FAj;;;-'_,E:i:>f.'rR -2 !"I';I" Il~?T I""" AUTOMOBILE LIABILITY A i 1,.,;...:y/.l,;TO 1-: p. 1 ':-\'I.'I~':::. "_h)~ I <.l>JEcl,!L''''-lIJ-.oS ~".'Rj;:'>'r""'~ [X_: "Afl.','"",'t-I)""lTr~ ! 02/01/081 02/01/09 r;:;:lIIe r-.f~ "I:..,' [ c~,~1l ':!:'~ JC(~~:rt". 1--- ~()l)IL \' 'II.' ii'" ,1(r>c'Q~\!;,,;lI_ 'RCe!l' ;~'LU,' 1 ipe...e,,""r,", i~l.OOO,OOO I j !' ",,'. "-' 1 -1 I I ~R('PEV{C,..IMAr:;:: i ~ '-'", ~,r(j~,'t) I. I '.1.'10C,~LI EAAL'(IUHJr '$ I -~A,RAG~ i il:1-EP h/~~' AJ~\) cr'"'l [,~ I\~L ; $ ---;;;.1, EXCESSlUMBRE:LLA UA6lUTY A x I ",- 'J~ L. I ,- :,:~,'~\.tt.L'" i CUP20689153444 02/01/00 02/01/09 !.~'~hL',~:URr(~~__ :.~~, OO~OO~ I A:;:,RtG/...rr ,$ .. I, f-- --. +:- ~ - .-~~~- iJWj' ~;"!AI'J' I; T~',~-.,rl~IT~ ~ ~~ ~ ~""(ll""crl,,~';r . ,~~ I ~ :IEL'~I.; T 11:".- 'x I :;?Flt'.I";(YI '$10,000 W(lRhe:~s CO'-lPENSATION AND eM'PLOYEf'SLIABIL,TY ~~, oi'~'IL 1 "h'..1-'?X> ,I .",~ 'E(L'T ,\'~ '\11 i,'Gr ~ ~'-:.' .l'~~'~ I" I - -+----- II, L DISF' ",;:;( C '" ~M"" <'WEE Ii' " t: L l~':-,~olSE. FCLlL "I.:.1! ,S "I!-:~'~;""~~~'.'I<;J~', , ~~;. P",!,.ISI~.~, ~,~IO", B ! Professional I EEA276170923 LJ._bility (1:&0) , OESCRIPTION OF OPERATiONS I LOCATIONS I VEHI\:LES I EXCLUSIONS ADDEO BY ENooRselli::iIIT iSriECIAL'~ - **REVISES , REPLACES CERTIFICATE ORIGINALLY ISSUED 02/15/08** Certificate Holaer is additional insured as respects to General Liabili~y per written contract per attached G-17957-G99 The CANCELLATION notice herein is ~nde~ to re~d 10 daY8 as ~espects any cancellation due to non-payment o~ pr~um, 02/01/08 I 02/01/09 Claim!A9Q Deduct, 3,000,000 100,000 CERTIFICATE:: HOLDER CANCELLATION CITYSAA M"OULO ANY UF T~ JlflCVE DESCRIBED POlICIES BE' CANCELLED BE"):ORE THE EXPIRATION OAT!:. THEREOF, THEISSUI~Go 'NSURERWllL ENDEAVOR TO MAIL 30 OAYSWRITIEN city of Santa Ana Department Of Pub11C 220 S. Daisey Ave, Santa Ana CA 92703 Works NOTICE TO TI1E CERTlFICAlll-<OtDERNAMED TOniE LEFT, BUT FAlLUR€ TOOO 8U SHALL IMPOSE N('J OBi IGATION OR l1Ml1U1"f OF ANY IUND UPON THE lNSIJREFl, If:> AGENTS OR REPRF.SENrATNlS, ACORD 2~ (20D1!D8) , , @ACORDCORpOR,6.TION1988 ~tl//~._-- . . '.. ' , , . '....t .'1,-."" 1.". ,._ v 38 Public Works Apr O!_'_~'~L C~~'~'<'i"",r\....o l"olXIU tJ~lJ--j18-4361 To'Thomll"iO 7146473345 p.3 Date 4/112008 '1 13 AM Page "3:A 4 IMPORTANT If the cer':ifIcate holder is an ADDIT ONAl INSUReD, the polll;Y(le~) must be endorsed A statement on this r-ertlflcate does not confer rights to the certificate t;otder it) !lOli of such endorserr.ent(s). It SUBROGATION IS WAIVED, subject to Ir.e tern"'8 and condltlu'lS of the policy, certain policies may leqUlre an endorsement. A statement on 111S certificate does not confer rights to the certificate holder In IleL' of such e'll1orsement(s) DISCLAIMER fhe Certificate of Ins,JfClnce an the reverse Sldf' elf tnis (urm does not l.:onstltute a conlral...1 between the issuing Insurer(s), authonzed represematlve or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or dltL:! [tIe coverage afforded by the policies iisted thereon ACORD 25 (2001108) Apr 01 08 03:39p ._v~""~"- n,.,",,'U'~lIl1u.""O Public Works I-a)clU lobO 378-4301 Tn Them..!;. 0 7146473345 p.4 Date 4/1/200B 1113AM Plilge .::or4 CERTHOI.OER COPY SG STATE COMPENSATION INSU~ANCE FUND P,O, BOX 420B07, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE OATE: 04-01-2008 GROUP POLICY NuM8L~ 18S6779-2OO8 CER1IFICAT[ 10: 4 CERTIf'CATE eXPIRES, 02-01-2009 02-0'-2008/02-01-2009 CITY OF SANTA ANA DEPARTMENT OF PUSCIC WORKS 220 5 DAISV AVE SANTA ANA CA 92703-4334 SG rhls is lu cerUy that we hove issLOed a 'IIalid Worlo.ers' CompEnsation insur.ance poliev .n . for:n approved by the C.;..ifornis hsurance Commissioner :0 the efl1plove-r named ba:ow tor lhe ;JOhe, jHl('od ,ndicated. Tlll'~ ;..JOlley IS not SL.bJ6CI to c.a'1cellatlO'l by the Fund exce>o;: Jpon 10 aays ..d....lI'lce v\ntten notice to the ~mPIQr'er. 'oNe Will also gl1l8 '/01.. 10 days ad~'aroce "'Iohce should thii. ;::Jolley oe cancelled prior to Its norm&! e.xjJifation. lhl~ ~ertllicill~ uJ I'lSUfiilll,;e 13 nol an inSUr4nt:e poliCY ar.d ODes 'lOl 4mend, extend ur lIlter lhe coverage affOlded by thll policl 'I.:;.ted here.n. NctwithStanCIinll any reQUir8lY'ent, ~Elfll1 0: cO'1ditlon 0+ i"'lY :ontrJlct or other r:1oc:umen1 with reSDect te whlc~ this certificate of i'lsunmce may Of' ISSU.eO or to .......hich it mi:lY pertain, the insurance ;]florded by ,ht/ poliCY described r>erOln IS ;;;ubJeC:l to all the terms el(c.lusIO.,S, and conditions, of such policy_ ',eORIZED REP::::O ~~t~ EMPLOYER'S lIABILIT~ LIMIT INCLUOINO DEFENSE COSTS $1.000.000 PER OCCURRENCE, EMPLCY!;R CLINICAL LABORATOAIES OF SAN BERN AND/OR GEO MONITOR INC PO BOX 329 SAN BERNARDINO CA 92402 (REV 2-1l"'1 j1D IB1S,NAI PRINTED 04-01-2008