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PROOF OF INSURANCE (2020) CLOSED 0 DATE(MMIDDIYYYY) l CERTIFICATE OF LIABILITY INSURANCE I 1/30/2019 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(ill 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' n Chavez Wood Gutmann & Bogart Insurance Brokers PHONE to ��� I FAX License 0679263 VVP.,No, Ot). 4-450-1660 (ANC,N E MAIL 15901 Red Hill Ave., Suite 100 ADDl fctYsw z vF bib.com Tustin CA 92780 INSURER(S)AFFORDING COVE RAGE � NAIC M INSURER A:Transportation Insurance Co. L INSUR„,, .... .... ....CLINI-2 ,,.... ..... ,,, INSUR Clinical Laboratoryof San Bernardino, Inc. INSU_ Continental A Casualty Co ED INSURER D Property INSURER C Hartford Acc&Indemnity Co Geo-Monitor, Inc. SSSS - PO Box 329 ...&Casualty San Bernardino CA 92402 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1488892619 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, NSR .. ... ..A6bL'MJbk Ptucy EFF � cNc,"*P TYPE OF INSURANCE NRRWD POLICY NUMBER iMMYMMU DYYYY1 ......IM ITS A ,... .,...... GENERAL LIABILITY 6072997663 2/1/2019 2/1/2020 EACH OCCURRENCE $1,000,000 — 15AMAUL YO kENl Elf) X _LIABILITY PREY ($a ggqy a! ,$100 000 COMMERCIAL GENERAL _ CLAIMS MADE OCCUR MED EXP(Any one person) $10,000 . . . PERSONAL&ADV INJURY $1.000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,,000,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 'I POLICY L.,X,I P'Rol• ( LOC I $ C AUTOMOBILE LIABILITY 72UECHF6015 2/1/2019 2/1/2020 CGOMBiNE.D SIN(°LE LIMIT ff4ArVBODILY INJ)... - ._._ILS 1 p0(?QOQ -- Y — BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY ALL OWNED SCHEDULED (Per accident) $ AUTOS .... HRT DSAUTOS AUTOS R c M2Y 5 .... .... X X rt - -- NON-OWNED PROErIYAMli`E� $ A X UMBRELLA LIAB .."X UR 6076261162 2/1/2019 2/1/2020 SII EA OCCURRENCE $5,000,000 EXCESS IAB I RETENTN $^1q 0 CLAIMS-MADE AGGREGATE $60 00,000 DEDX D WORKERS COMPENSATION 72WECAS6498 2/1/2019 2/1/2020 IXWC STATU-I 1OTH- TORY I MITS.............�...�ER, .................. YIN AND EMPLOYERS'LIABILITY II E L DISEASE- EMPLOYEE $ Mandato m NH $1,000„000 (Mandatory ) 1,000,000 ANY PROPRIETORIPARTNER/EJ(ECUTIVE E L EACH ACCIDENT OFFICER/MEMBER F�CCLUDED� N/A If yes,describe under E L DISEASE-POLICY...........�,� .................. ... DESCRIPTION OF OPERATIONS below LIMIT $1 000,000 B Environmental Professional Liabil EEH276170923 2/1/2019 2/1/2020 Per Claim 3,000,000 Claims Made Coverage Aggregate 3,000,000 Deduaible:$100.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of EI Segundo,its directors,officials,employees,agents and volunteers named as additional insured on the General Liabitity per attached CNA75081XX(1-15)as required by written contract subject to the terms and conditions of the policy,'Waiver of Subrogation appties to the General Liability per attached CNA75008XX(1-15).Waiver of Subrogation applies to the Workers'Compensation per attached WC040306. CERTIFICATE 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 PRESENTATIVE EI Segundo CA 90245 AUTORYZ � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations C°verage " L�mited 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 N 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 N 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: CNA75081XX (1-15) Policy No: 6072997663 Page 1 of 2 Endorsement No: 6 TRANSPORTATION INSURANCE COMPANY Effective Date: 02/01/2019 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. ................ CNA75081XX 1-15 Policy No: 6072997663 Page 2 of 2 Endorsement No: 6 TRANSPORTATION INSURANCE COMPANY Effective Date: 02/01/2019 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 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 p 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. .._._._._......_._._......----- .w................................ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The Insurer is amended by the addition of the following: Solely 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 done under a contract with that person or organization and 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. ...................................__........................_. ................................................. ........... CNA75008XX (1-15) Policy No: 6072997663 Page 1 of 1 Endorsement No. e TRANSPORTATION INSURANCE COMPANY Effective Date: 02/01/2019 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 AS6498 Endorsement Number: Effective Date: 02/01/19 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 from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 12/23/18 Policy Expiration Date: 02/01/20