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PROOF OF INSURANCE (2018 - 2019) CLOSED BABCLAB-01 BSURESH
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
llk� 1 03/29/2018
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 have ADDITIONAL INSURED provisions or 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 License#0757776 CONTACT Patricia Finnerty
N/.#MF6
HUB International Insurance Services Inc. PHONE ) FAX
Ri.Box CA 92517 (A/C,No E (9551 779-8545 IAIC,No):(951)231-2572
� s
Cal,CPUehublinternatiorial.com
INSURER(S)_AFFORDINGCOVERAGENAIC,9
INSURER A The Travelers Indemnity.Company„of Connecticut 25682
INSURED INSURER B:Travelers Property Casualty Company of America 25674
Babcock Laboratories,Inc. INSURER C:Protective Insurance Com anv 12416
Edward S.Babcock&Sons Inc. INSURER D:AXIS Surplus Insurance COmpan
P.O.Box 432 A y 261320
Riverside,CA 92502 INSURER E!
INSURER F:
COVERACa'E ... ._..............._......�...................................wCERTIFICATE NUMBER: REVISION NUMBER:
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 POLIr,IES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
EXP
1L� TYPE OF INSURANCE... ....� o SWVD POLICY NUMBER (M&ypp=_AWpPOLICY EFF YL. ..... LIMITS
DAMAGE 1,000,000
A X coMMLAIMS-MADEX I OCCUR 6307F65965ATCT17 05/28/2017 05/28/2018 T O EN $
I GENERAL
X PRCAAI$�,CCURRENCE $
.,„ EACHO...,
lost) 100,000
MED EXP,(Any 29p person), $ 5,000
PERSONAL a nPM!NJURY $ 1,000,000
AGGREGATE $ 2,000,000
GC:I�' iC:LIMIT APPLIES PER: PRODUCT
G011.AGGREGATE.A,
POLICY X F LOC 2,000,OUO
JECOT S COMPIOPAGG, $,
OTHER $ _
B
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
X ANY AUTO 8A7F65965A17CAG 05/28/2017 05/28/2018 BODILY,INJURY(Per person)„ $
BO IL INJURY(Per accident), $
AUTOS ONLY AWNED S
B
X... AUTOS ONLY X. A�Op ONLYY P ere a tlent�DAMAGE $
S
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS L
IAB CLAIMS-MADE
AGGREGATE $
DED �,RETENTI
ry ON$ II$
C OFOFCERIMEREXC �Y! N/A SW"2305541-01 0110212018 01/0212019 E I PER ACCIDENT
H-
AND 1,000,000' 0
OFFICE(MandaPROPRIETOR/PARTNER/EXECUTIVE EXCDY E L DISEASE L EACH A FMPI.,(.IYEE, $ 1'000'000
If yes,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE„,_,-,,,POLICY_LIMIT $ 1,000 000
D Professional Llab ECN000030551701 05/28/2017 05/28/2018 Ded$100?UEach$1M/Agg 1,000,000
.__...............................
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be alt'acbed if more space is required
Revised 3/29/2018-This certificate rescinds and supersedes any and all prior certificates'dssued on behalf of the required
Insured.
City of EI Segundo its officials and employees are Additional Insured with regard to General Liability when required by written contract per the attached
endorsement form CGD414 04/08.Primary&Non-Contributory wording applies with regard to General Liability when required by written contract per the
attached endorsement form CGD037 04/05.
Should the policies be cancelled before the expiration date,Hub International Insurance Services Inc.(Hub),independent of any rights which may be afforded
within the policies to the certificate holder named below,will provide to such certificate holder notice of such cancellation within thirty(30)days of the
SEE ATTACHED ACORD 101
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City 9 ACCORDANCE WITH THE POLICY PROVISIONS.
Attn:Anthony Esparza
Water Division .....
400 Lomita St. AUTHORIZED REPRESENTATIVE
EI Segundo,CA 90245 41VI
ACORD 25 2016/03 ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:BABCLAB-01 BSURESH
1
LOC#: 0
C ADDITIONAL REMARKS SCHEDULE Page .--I of 1
...............................
AGENCY License#0757776 NAMED INSURED
UB International Insurance Services Inc. Babcock Laboratories,Inc.Edward S,Babcock&Sons,Inc.
.....�............._.....................................................................
POLICY N ..............
UMBER P.O.Box 432
EE PAGE 1 Riverside,CA 92502
CARRIER NAIC CODE
EE PAGE 1 SEE P 1 EFFECTIVE DATE SEE
PAGE 1 ..
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: J PPRP 25 FORM TITLE Cq Ifl AA of L�q!)lily!Insurance
Description of Operations/Locations/Vehicles:
cancellation date,except in the event the cancellation is due to non-payment of premium,in which case Hub will provide to such
certificate holder notice of such cancellation within ten(10)days of the cancellation date.
ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
INSURED: Babcock Laboratories, Inc.
POLICY NUMBER:6307F65965ATCT17
EFFECTIVE DATE:05-28-2017 to 05-28-2018 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
BLAN�KET ADDITIONAL INSURED - WRITTEN
CONTRACTS (ARCHITECTS, ENGINEERS AND
SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following is added to SECTION II —WHO IS plies only to such "bodily injury" or "property
AN INSURED: damage"that occurs before the end of the pe-
Any person or organization that you agree in a riod of time for which the "written contract re-
written contract requiring insurance" to include as quiring insurance" requires you to provide
an additional insured on this Coverage Part, but: such coverage or the end of the policy period,
whichever is earlier.
a. Only with respect to liability for"bodily injury",
"property damage"or"personal injury"; and 2. The following is added to Paragraph 4.a. of SEC-
TION IV—COMMERCIAL GENERAL LIABILITY
b. If, and only to the extent that, the injury or CONDITIONS:
damage is caused by acts or omissions of
you or your subcontractor in the performance The insurance provided to the additional insured
of "your work" to which the "written contract is excess over any valid and collectible "other in-
requiring insurance" applies. The person or surance", whether primary, excess, contingent or
organization does not qualify as an additional on any other basis, that is available to the addi-
insured with respect to the independent acts tionai insured for a loss we cover. However, if you
or omissions of such person or organization. specifically agree in the "written contract requiring
insurance" that this insurance provided to the ad-
The insurance provided to such additional insured ditional insured under this Coverage Part must
is limited as follows: apply on a primary basis or a primary and non-
c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to
this Coverage Part shown in the Declarations "other insurance" available to the additional in-
exceed the limits of liability required by the sured which covers that person or organization as
"written contract requiring insurance", the in- a named insured for such loss, and we will not
surance provided to the additional insured share with that 'other insurance". But this insur-
shall be limited to the limits of liability required ance provided to the additional insured still is ex-
by that "written contract requiring insurance". cess over any valid and collectible "other insur-
This endorsement shall not increase the limits ance", whether primary, excess, contingent or on
of insurance described in Section III — Limits any other basis, that is available to the additional
Of Insurance. insured when that person or organization is an
d. This insurance does not apply to the render- additional insured under any"other insurance".
ing of or failure to render any "professional 3. The following is added to SECTION IV — COM-
services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS:
or omissions. Duties Of An Additional Insured
e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi-
jury" or "property damage" caused by "your tional insured:
work" and included in the "products-
completed operations hazard" unless the a. The additional insured must give us written
"written contract requiring insurance" specifii- notice as soon as practicable of an "occur-
cally requires you to provide such coverage rence" or an offense which may result in a
for that additional insured, and then the insur- claim. To the extent possible, such notice
ance provided to the additional insured ap- should include:
CG D4 14 04 08 0 2008 The Travelers Companies. Inc. Page 1 of 2
COMMERCIAL GENERAL LIABILITY
1. How, when and where the "occurrence" any provider of other insurance which would
or offense took place; cover the additional insured for a loss we
!I. The names and addresses of any injured cover. However, this condition does not affect
persons and witnesses; and whether this insurance provided to the addi-
Ill. The nature and location of any injury or tional insured is primary to that other insur-
damage arising out of the"occurrence"or ance available to the additional insured which
offense. covers that person or organization as a
named insured.
b. If a claim is made or "suit" is brought against
the additional insured, the additional insured 4. The following is added to the DEFINITIONS Sec-
must: tion:
I. Immediately record the specifics of the 'Written contract requiring insurance" means that
claim or"suit"and the date received;and part of any written contract or agreement under
fl. Notify us as soon as practicable. which you are required to include a person or or-
ganization as an additional insured on this Cover-
The additional insured must see to it that we age Part, provided that the "bodily injury" and
receive written notice of the claim or"suit" as "property damage" occurs and the "personal in-
soon as practicable. jury"is caused by an offense committed:
c. The additional insured must immediately send a. After the signing and execution of the contract
us copies of all legal papers received in con- or agreement by you;
nection with the claim or"suit",cooperate with b. While that part of the contract or agreement is
us in the investigation or settlement of the in effect; and
claim or defense against the "suit", and oth-
erwise comply with all policy conditions. c. Before the end of the policy period.
d. The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
Page 2 of 2 0 2008 The Travelers Companies,Inc. CG D4 14 04 08
INSURED: Babcock Laboratories, Inc.
POLICY NUMBER:6307F6596SATCT1 7
EFFECTIVE DATE:O6'28-DD17tmO5-28'2O10 COMMERCIAL GENERAL LIABILITY
THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ Ul[ CAREFULLY.
OTHER INSURANCE — ADDITIONAL INSUREDS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROVISIONS b. The"personal injury"or"advertising injury"for
COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out ofan of-
(Section |V). Paragraph 4. (Other |nmurmmom), is fenoeuommitted
amended aofollows: subsequent to the signing and execution ufthat
1. The following is added to Paragraph o' primary contract oragreement byyou.
Insurance: 2. The first Subparagraph (2) of Paragraph b. Em-
Howevar. ifyou specifically agree inawritten con- mess Insurance regarding any other primary in-
tract orwritten agreement that the insurance pro- sumnue available toyou iadeleted.
vidad to on additional insured under this 3. The following is added to Paragraph b. Excess
Coverage Port must apply on a primary basis, or |nsunance, as an additional subparagraph under
o primary and non-contributory basis, this inxur- Subparagraph (1):
anne is primary to other insurance that is u«ei|' That isavailable tothe insured when the insured
able oosuch additional insured which covers such
isadded aoanadditional insured under any other
additional insured as m named insured, end we
policy, including any umbrella orexcess policy.
will not share with that other insurance, provided
that:
a. The "bodily injury" or "property damage" for
which coverage issought occurs; and
CG 0D 37 04O8 Copyright 2005 The SL Paul Travelers Companies, Inc.All rights nooemod. Page 1 of 1