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2021/06/01 Biotox LaboratoriesP52(U112811112 Edgewood Partners Insurance Centers (EPIC) P.O. Box 5003 San Ramon, CA 94583 Electronic Service Requested ALL FOR AADC 923 202106073318 6261 1.0129 AB 0.416 III II'���I�'�'�'�'�'�I�"Il��lllllll��lllrllllllll�lll'��"III" City of Menifee 27 & its officers, employees, agents, & authoriz•eers 29844 HAUN RD MENIFEE, CA 92586-6539 EBIX BPO This document was brought to you by CertificateeNow. - If you have questions regarding the content of this document, please - call (925) 244-7700 and ask for an available certificates team member. - For new certificate requests or if you need changes made to an existing certificate, - please forward the current certificate issued with requested changes - via E-Mail: EPICcertsLaepicbrokers.com or Facsimile: (925) 901-0671- Please Note: All requests for new certificates or changes to existing certificates must be requested by the Named Insured. - cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 P5260028002 d !{•'••�� DATE (MMIDDIYYYY) /'1CERTIFICATE OF LIABILITY INSURANCE 06/04/2021 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 pelicy(ies) must have ADDITIONAL INSURED previsions 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 endorsemenl(s). PRODUCER CA LIC OB29370 1-925-244-7700 CONTACT Certificate Department Edgewood Partners Insurance Centers (EPIC) PHONE (925) 244-7700 FA% (925) 901-0671 CNo [Inland Empire - Branch ID 14542] MAIL P.O. Box 5003 ApgR6Ss; EPICeerta®epiebrokers.com San Ramon, CA 94583 INSURED Biotox Laboratories 1965 Chicago Avenue, Suite C INSURER A: LANDMARK AMER INS CO INSURERS: OHIO SECURITY INS CO INSURER C : INSURER E : Riverside, CA 92507 1 INSURERF: COVERAGES CERTIFICATE NUMRER� 62377668 RFVICIAN NIIMRFR• NMI 33138 24082 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. INBR TYPE OF INSURANCE AODL SU R POLICY EFF POLICY EXP POLICYNUMBER 1MMf0DffyYYI IMMIDONYM LIMITS A X COMMERCIAL GENERAL LIABILITY LHC843218 06/01/21 06/01/22 EACH OCCURRENCE $ 2,000,000 X CLAIMS -MADE ❑ OCCUR DAMAGE To RERTM57-- PRMSES Ea $ 50,000 X MED EXP (Any one person) $ 51000 BI/PD Ded: 2,500 X Retro Date: 10/1/17 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 1:1JEC LOC GENERAL AGGREGATE $ CombinedAgg PRODUCTS - COMP/OP AGG I*CombinsdAgg $ COmbinedAgg $ 4,000,000 OTHER: B AUTOMOBILE LIABILITY BAS2257312760 06/01/21 06/01/22 CCMe1NE0SINGLELIMITMe accldgntl $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE [�w fl rddq Q $ UMBRELLA LIAB OCCUR EACHOCCURRENCE $ $ EXCESS LIAB CLAIMS -MADE AGGREGATE DED 1 1, RETE TION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA PER O H- STATUTE ER _ $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A E&0 LHC843218 06/01/21 06/01/22 Medical/Prof Liab 1 2,000,000 Claims -Made *Combined Agg 4,000,000 Retro Date: 10/1/17 $2,500 DED DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) RE: Forensic Toxicology Services / ADDITIONAL INSURED: City of Menifee & its officers, employees, agents, & authorized volunteers CERTIFICATE HOLDER CANCELLATION City of Menifee & its officers, employees, agents, & authorized volunteers 29844 Haun Road Menifee, CA 92586 1 USA ACORD 25 (2016103) kstubbs-oat 62377668 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rszroozauoz LANDMARK AMERICAN INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any Person or Organization As Required By Written Contract The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US: We waive any right of recovery we may have against the parson or organization shown in the SCHEDULE, above because of payment we make for injury or damage arising out of your ongoing operations. "your product" or "your work" done under a written contract with that person or organization and included in the "product -completed operations hazard", This waiver, applies only to the person or organization .shown in the SCHEDULE above, This endorsement effective 06/01/21 Forms: part of Policy Number LHC843218 Issued to BIO TOX LABORATORIES INC by Landmark American Insurance Company Endorsement No.: 13 RSG 54078 0310 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services office, Inc., N09 N z w P5260028002 Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or s organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance, 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: s SECTION II - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto' you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 P5200028002 I This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 23. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.5. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V - DEFINITIONS is amended as follows: 24. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS , Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7