PROOF OF INSURANCE (2019 - 2019) CLOSED BABCLAB-01 SGONZALEZ
A RO CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD/YYYY)
llik, � 0512812018
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(les)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 endomement(s).
PRODUCER License#0'7'57776 rT Patricia Finnerty
HUB International Insurance Services Inc. PHONE a,E t):(851)778-8545 FAX, x):(951)231-2572
P.0.Box 6346
Riverside,CA 92517 'fess;cal.cpuhubinternational.com
tNSURER(S)AFFORDING COVERAGE NAIL 0 I
INSURERANaliey',Forge Insurance Company 20508
INSURED 1NSURER8:Continental Casualty Company 20443
Babcock Laboratories,Inc. INSURER C:Pr'ote'ctive Insurance Company 12416
Edward S.Babcock&Sons,Inc.
P.O.Box 432 INSURER D Axis Surplus insurance Company 25520
Riverside,CA 92502 INSURER E:
INSURER F
COVERAGE'S CERTIFICATE 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INS_W.p.' (MW 1
A X COMMERCIAL GENERAL LIABILITY EACH O'CCURR'ENCE S 1,000,000
CLAIMS-MADE X OCCUR 6071825747 05/28/2018 05/28/2019 OAMA 'E TO RENTED 100,000'
X PRSMII ES(Fa ocrorreplce) $
MED EXP(Any one person;) $ 5,000'
PERSONAL S ADV INJURY $ 1,000,000
GE'N1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $, 2„000,,000
X POE.ICY P�r LocPRODUCTS-OOMPIOP'AGG $ 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY COM'BI'NED SINGLE LIMIT 11000,000
Ilya
X ANY AUTO 8071825750 05/28/2018 05/28/2019 1
BODILY
LY INJNJl $URY(Par person)
OWNED SCHEDULED
AUTOS ONLY AUTOS
WN p BODILY INJURY(Par ecrldsnt) S
X AUTOS ONLY X Al 6 O 5 (Parr ecGR�nI?AMAGE S
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LLAB CLAIMS-MADE AGGREGATE S
DED RET'ENTION!$ S
C WORKERS COMPENSATIONPER OTH•
AND EMPLOYERS'LIABILITY X STATUTE ER'
YIN SW-2305541-01 01/0212018 01/02/2019 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE 1 E.L.EACH'ACCVDEp�lT' S
FILEq/MEM EXCLUDED? Y N I A
lendetory In�F�j 1,000,000
If yes,describe under E L.OISEaSE, FA EMPLOYEE: $
PESCRIPTION OF OPERATIONS below LEL piSEgF•Ppoapp a S 1,000,000
D ,Professional Llab ECN000030551801 05/28/2018 05/28/2019 Ded$100K/Each$1M/A99 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,mebe attached If more space Is required)
City of EI Segundo Its officials and employees are Additional Insured with regard to Moral Liability when required by written contract per the attached
endorsement form CNA75079XX 10/15,Primary&Non-Contributory Included.
'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
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.
_qgR11F&A1gA0LDER 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 g ACCORDANCE WITH THE POLICY PROVISIONS.
Attn:Anthony Esparsa
Water Division
400 Lomita St. AUTHORIZED REPRESENTATIVE
EI Segundo,CA 90245
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART ,
It is understood and agreed as follows:
I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily Injury, property damage or personal and advertising Injury caused in whole or in part by your acts or
omissions, or the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such written contract; or
B. in the performance of your work subject to such written contract, but only with respect to bodily injury or
property damage included in the products-completed operations hazard, and only if:
1. the written contract requires you to provide the additional insured such coverage; and
2. this coverage part provides such coverage.
II. But if the written contract requires:
A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the
10-01 edition of CG2037; or
B. additional insured coverage with "arising out of language; or
C. additional insured coverage to the greatest extent permissible by law;
then paragraph I. above is deleted in its entirety and replaced by the following:
WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required
by written contract to add as an additional insured on this coverage part, but only with respect to liability for
bodily injury, property damage or personal and advertising Injury arising out of your work that is subject to
such written contract.
III. 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.
IV. 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. 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
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended
to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this
coverage part:
Primary and Noncontributory Insurance
CNA75079XX (10-16) Policy No: 6071825747
Page 1 of 2 Endorsement No: 001
Valley Forge Insurance Company Effective Date: 05/28/2018 to
Insured Name: Babcock Laboratories, Inc. 05/28/2019
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a
written contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured; or
2. primary and to not seek contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional
insured.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
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. 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
3. make available any other insurance, and 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 3.
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.
VII. 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 you 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..
CNA75079XX(10-16) Policy No: 6071825747
Page 2 of 2 Endorsement No: 001
Valley Forge Insurance Company Effective Date: 05/28/2018 to
Insured Name: Babcock Laboratories, Inc. 05/28/2019
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission.