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DocuSign Envelope ID:9EAFBE54-OC17-4035-9610-6143BA641245 <br /> r� <br /> Ri CERTIFICATE OF LIABILITY INSURANCE DATE 1 20 1 9 Y} <br /> Q812812019 <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 pOIICy(IGS)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> 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 CONTACT <br /> NAMEi <br /> EXECUTIVE ONE INSURANCE SERVICES PHONE FAX <br /> (AIC,No,Ext); IAIC,No]: <br /> 415 E.HARVARD ST.#103 E-MAIL <br /> ADDRESS: <br /> GLENDALE.CA 91205 INSURER(S)AFFORDING COVERAGE NAIL p <br /> INSURER A:.EVEREST PREMIER INSURANCE COMPANY <br /> INSURED INSURER B <br /> SENSOSCIENTIFIC,INC - <br /> 685 COCHRAM STREET#200 INSURER C <br /> SIMI VALLEY,CA 93065 INSURER D-.— <br /> INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: 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 13E 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' -- - -'ADD#.SUSRI — --- POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM7DDIYYYY MMIDD)YYYY LIMITS <br /> GENERALLIA91LITY EACH OCCURRENCE -5 <br /> __ COMMERCIAL GENERAL LIABILITY 1 i ISES(Ea 2pL DL ej <br /> PREMISES.IEa oopmence]_ <br /> FCLAIMS-MADE l-_i OCCUR MED EXP(Any"person) $ <br /> PERSONAL&ADV INJURY S <br /> GENERAL AGGREGATE S <br /> I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ <br /> POLICY PRO• LOG COM _ <br /> AUTOMOBILE LfABILrrY F qab I c G IN LE LIMIT — <br /> Ea accidep� S <br /> ANY AUTO i 9ODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED 930DILY INJURY(Parawdent) S <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY b-AMAGE S _ <br /> HIRED AUTOS AUTOS Per accident]-_,_ <br /> I � S <br /> UMBRELLA LIAR OCCUR 7 F_ EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADF. AGGREGATE S <br /> DF.D RETENTIONS 5 <br /> WORKERS COMPENSATION WC S7ATU• OTH• <br /> AND EMPLOYERS'LIABILITY x TQRY I 7 - ER�^ <br /> A ANY P ROPRIETORIPARTNEWEXECUTIV[ YIN C S 1 QQQQQO <br /> OFFICFIMEMI}ER E7(GLUDED� �X' N f A F 76000200571191 0112912018 01I2812020 E L EACH AC CI-- .- <br /> 'Mandatory in NH] I E.L DISEASE-EA EMPLOYEE 5 1000000 <br /> nIF yea,describe under 4:8CRIPTIQN OF OPERATIONS Wow E-L DISEASE•POLICY LIMIT S 1000000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 1a7,Additional Rernarks Schedule,if more apace Is required] <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGE COUNTY HEALTH DEPARTMENT SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 300 TRYON STREET ACCORDANCE WITH THE POLICY PROW NS, <br /> HILLSBOROUGH,NC 27278 <br /> AUTHORIZED REPRESENTATIVE <br /> 198 1 CORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered s of ACORD <br />