PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MM/°°"""'
1/31/2022
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 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 endorsement(s).
PRODUCER CONTACT
NAME; Candace Cordova
Wood Gutmann & Bogart Insurance Brokers PHONE— FAX
""""
License 0679263 1A . ��,, �I; 714-82..... kArc, Nip
E-MAIL
15901 Red Hill Ave., Suite 100 wwnss rcordova@wgbib.com
Tustin CA 92780
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER.
....., �,.., � „ , .ee .. A-:, Continental Casualty Co
INSURED CUNI-2 INSURER B : American Cas Co of Reading PA _ n 20427
Clinical Laboratory of San Bernardino, Inc.
Geo-Monitor, Inc. INSURERC: Continental Insurance Company..
PO Box 329 iNsuRER o Hartford Underwriters Ins Co
San Bernardino CA 92402 INSURER United Financial Casualty Co__ �11770
11 INSURER F
Cf1VFRArFS CERTIFICATE NIIMRFR• 3F4971R9A REVISION NLIMRFR1
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 ADDL St}BR
TYPE OF INSURANCE POLICY NUMBER...° MMIDDY/YYYY @PflMCCYfi'lYXt"Y�
LTRIN5RB
LIMITS
GENERAL LIABILITY .'' 6072997663 21112022 2/1/2023
EACH OCCURRENCE. $ 1,000.0D0
,,,,, .
XCOMNAEFZCIAl.. GENERAL LJABIL.ITY
..,
PRE Nvt*ES l;E,a Cat.»{irr wwgy.gi S t,o0 0D0
,e
'.. CLAIMSMADEX '.. OCCUR
MED EXP (Any one person.$ 10,000
'... '..
.. _,,,,..,,,,,,,,,,
i PERSONAL. & ADV INJURY'. $ 1,900 000
'.....
Gr NEFtAI.. AL;�CRE;CsrTT£ $ 2.000.000
K"sENL.AGGREGATE I..IMITAPPI..IESPFR '..... '..., '......
GE
F�FC71UI„'F'-COIUIP/OPAUG 52.000.000
_m
POLICY X M X I..00
S
E AUTOMOBILE LIABILITY 005631382 4/312022 4/3/2023
I
CO"' BINEE' 8y NdaUE ILkN1 T
-(Ea a 4Fyi'!71). . a 7,26]f70 J00
%� '...... ANY AUTO ''.., ,..
BODILY INJURY (Per person) S
'.�., „ ,,.....,,, ...... _ „,,.�,
AL.L.OWNED .-....... SCHEDULED
BODILY INJURY (Per accident) S
®, AUTOS AUTOS
NON OWNED
X
,....X.
........
''ROFHE6TT"kGTAWcM1AF $
.®......., '.. HIREDAUTOS AUTOS
Per aocidrin4/ ........
C '.. X '.. UMBRELLA LIAR.... X OCCUR '.. CUE6076281162 2/1/2022 211/2023
'... hii ACIi I OCCURRl.NC,E::. S5. DOD 000
''. EXCESS LIAB '...... CLAIMS -MADE. ; '......
...X
AGGREGATE $ 5.000,000
—
DEE) RETENTIONS 10,000
S
E) WORKERS COMPENSATION 72WECAF.9FU9 - 211/2022 V112023
X A iJ� 0141
AND EMPLOYERS' LIABILITY YIN'..
r iJ`S�
ANY PROPRIETOR/PARTNER/EXECUTIVE �""""'�'�
E L EACH ACCIDENT $ 1,000 000
NIA
OFFICER/MEMBER EXCLUDED? K II
(Mandatory in NH)
E L DISEASE - EA EMPI_.OYEE $ 1,o00 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY I IMIT $ 1,0u)0,000
A Environmental Professional L.iabil '.. EEH276170923 2/1/2022 2/1/2023
Per Claim ES,000,000
'..... Claims Made Coverage
Aggregate 3,000,000
'..... Deductible: $100,000 '...... ',.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The City of El Segundo, its directors, officials, employees, agents and volunteers named as additional insured on
the General Liability per attached
CNA75081 XX(1 -15) as required by rewritten contract subject to the terms and conditions of the policy. Waiver of Subrogation applies to the General Liability per
attached CNA75008XX(1-15). Waiver of Subrogation applies to the Workers' Compensation per attached WC040306.
CERTIIFtCATE HOLDER CANCELLATION,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of el Segundo
400 Lomita Street
El Segundo CA 90245 PRssENrAa°vE' AUTHORIZE E
U 1988-2010 ACORD CORPORATION. All rights reservea.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
CNA CNA PARAMOUNT
Waiver of Transfer of Rights of Recovery Against
Others to the Insurer Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
... _......... ..M.... ._.._....... ............ .............
SCHEDULE
Name Of Person Or Organization:
............................................................_...._ ._.._._.
ANY PERSON OR ORGANIZATION WHOM THE NAMED INSURED HAS AGREED IN WRITING IN A
CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH
CONTRACT OR AGREEMENT:
1. IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART; AND
2. WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND
ADVERTISING INJURY GIVING RISE TO THE CLAIM.
(Information required to complete this Schedule, if not shown above, will be shown in the Declarations.)
Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled
Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following:
With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the
Insurer may have against such person or organization because of payments the Insurer makes for injury or damage
arising out of the Named Insured's ongoing operations or your work included in the products -completed operations
hazard.
All other terms and conditions of the Policy remain unchanged.
. ....._.. ........
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,
and expires concurrently with said Policy.
A75008 (10-16) Policy o: 6072997663
Page 1 of 1 Endorsement No. a
AMERICAN CASUALTY CO OF READING, PA Effective ate: 02/01/2022
InsuredName: CLINICAL LABORATORY OF SAN BERNARDINO, INC.
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc„ with its permission
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed Operations
Coverage - Limited Liability Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named
Insured is required by written contract to add as an additional insured on this Coverage Part; including any such
person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such
person or organization is an Insured only with respect to such person or organization's liability for:
A. bodily injury, property damage, or personal and advertising injury to the extent caused by:
1. the Named Insured's acts or omissions; or
2. the acts or omissions of those acting on the Named Insured's behalf,
in the performance of the Named Insured's ongoing operations specified in the written contract; or
B. bodily injury or property damage to the extent caused by your work specified in the written contract and
included in the products -completed operations hazard, and only if
1. the written contract requires the Named Insured to provide the additional insured such coverage; and
2. this coverage part provides such coverage.
II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide
such additional insured with:
A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and advertising injury arising out of:
A. acts or omissions of the additional insured, or of anyone acting on the additional insured's behalf; or
B. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
C. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,
the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional
insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written
contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to
insurance on which the additional insured is a named insured.
V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
..... .....................
CA75081X (1 15) Policy No: 6072997663
Page 1 of 2 Endorsement o: 6
TRANSPORTATION INSURANCE COMPANY Effective Date: 02/01/2022
Insured Name: CLINICAL LABORATORY OF SAN BERNARDINO, INC.
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc„ with its permission„
CNA
CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed Operations
Coverage - Limited Liability Endorsement
The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition
of the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the
additional insured has for any loss covered under this coverage part;
3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the
investigation, defense, or settlement of the claim; and
4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program
applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires
this insurance to be primary and non-contributory, this paragraph 4 does not apply to insurance on which the
additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
Written contract means a written contract or written agreement that requires the Named Insured to make a person
or organization an additional insured on this coverage part, provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. The bodily injury or property damage; or
2. The offense that caused the personal and advertising injury
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
..................... ..... _...... ....._.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
C A750 1 (1-15) Policy No: 6072997663
Page 2 of 2 Endorsement No. 6
TRANSPORTATION INSURANCE COMPANY Effective Date: 02/01/2022
Insured Name: CLINICAL LABORATORY OF SAN BERNARDINO, INC.
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc,, with its permission.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 72 WEC AE9FU9 Endorsement Number:
Effective Date: 02/01/22 Effective hour is the same as stated on the Information Page of the policy,
Named Insured and Address: CLINICAL LABORATORY OF SAN BERNARDINO, INC.
PO BOX 329
SAN BERNARDINO CA 92402
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization
Job Description
Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from
us
Countersigned by
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 12/28/21
Authorized Representative
Policy Expiration Date: 02/01/23