Loading...
2017 SR Dev Co - PSDA Letter Agr re revised insROBERT GREEN C 0 M 1' A N Y August 15, 2017 City of La Quinta 78-495 Calle Tampico La Quinta, California 92253 Attention: Frank Spevacek - City Manager Re: SilverRock Resort Insurance Requirements Dear Mr. Spevacek: SilverRock Development Company ("SDC") and the City of La Quinta ("City") are parties to that certain Purchase, Sale, and Development Agreement entered into by and between the City and SDC on or about November 19, 2014, and amended on or about October 29, 2015, and on or about April 18, 2017 (as amended, the "PSDA"). All capitalized terms in this letter have the meanings ascribed to them in the PSDA. SDC is hereby requesting that the City agree to a modification of the City's insurance requirements in Section 306.1 (a) — (d) of the PSDA with respect to the Golf Course Realignment and construction of the Temporary Golf Clubhouse. The full array of insurance requirements set forth in the PSDA were contemplated based on the full scope of the Project, rather than binding coverage appropriately scaled for each Phase. The result is insurance requirements which are, in certain preliminary Project Components, excessive and unnecessarily increase SDC's costs without any corollary benefit to the City. Therefore, SDC is requesting a waiver of certain of the PSDA's insurance requirements only with respect to the initial Golf Course Realignment and construction of the Temporary Golf Clubhouse. Subsequent Project Components, which include construction of, without limitation, Master Site Infrastructure Improvements, the Luxury Hotel, the Luxury Branded Residential Development, the Lifestyle Hotel, and the Lifestyle Branded Residential Development, would be subject to the full array of insurance requirements in the PSDA, unless the City were to grant a waiver, in writing, to some or all of said insurance requirements, based on a specific written request. Exhibit "A" attached hereto makes a comparison between the insurance requirements set forth in the PSDA and the insurance requirements SDC is hereby requesting be applicable with respect for the Golf Course Realignment and construction of the Temporary Golf Clubhouse only. If the requested insurance requirements are acceptable to the City, SDC will provide insurance certificates and endorsements evidencing said requirements in accordance with Section 306.3 of the PSDA. SDC appreciates the city's consideration. Sincerely, Cobert S. Green, Jr. cc: John Gamlin Tyler Kent Sonya Murillo The foregoing acknowledged and agreed this day of August, 2017 by: "CITY" CITY OF LA QUINTA, a Calico cor ti n and •hart - �IrOW!TV y F'ANK J. SPEVACEK ATTEST: municipal Susan Maysels, City Clerk 2 : r• EXHI BIT "A" PURCHASE, SALE, & DEVELOPMENT AGREEMENT SECTION 306 PSDA Requirements: Requested Insurance Requirements. Sec. 306.1(a) A policy of commercial general liability insurance written on a per occurrence basis in an amount not less than Five Million Dollars ($5,000,000.00) per occurrence and Five Million Dollars ($5,000,000.00) in the aggregate. Sec.306.1(a) Commercial Liability SilverRock Development Company, LLC has bound and requests approval of General Liability Coverage as follows: • $2,000,000 General Aggregate Limit . $1,000,000 Occurrence Limit Sec. 306.1(b) A policy of workers' compensation insurance in such amount as will fully comply with the laws of the State of California against any loss, claim or damage arising from any injuries or occupational diseases occurring to any worker employed by Developer in the course of carrying out the work or services contemplated in this Agreement. Sec.306.1(b) Workers Compensation — Currently the Developer does not have any employees and therefore is not required to maintain Workers Compensation Insurance. Any and all contractors used in the completion of the Phase I work will be required to maintain Workers Compensation Insurance meeting this requirement. 1 yj�(i1 Sec. 306.1 (c) A policy of commercial automobile liability insurance written on a per occurrence basis in an amount not less than Three Million Dollars ($3,000,000.00). Said policy shall include coverage for owned, non -owned, leased, and hired cars. Sec.306.1(c) Commercial Auto Liability Currently the Developer does not own any vehicles. Any persons affiliated with the Developer will provide evidence to the city of Auto Liability placed on their personal automobiles evidencing at least a limit of $250,000. 2 Sec. 306.3, P3 The policies of insurance required by this Agreement shall be satisfactory only if issued by companies (i) licensed and admitted to do business in California, rated "A" or better in the most recent edition of Best Rating Guide, The Key Rating Guide or in the Federal Register, and only if they are of a financial category Class VII or better, or (ii) authorized to do business in California, rated "A+" or better in the most recent edition of Best Rating Guide, The Key Rating Guide, or in the Federal Registry and only if they are of a financial category Class XV. Notwithstanding the foregoing, in the event that the policies required hereunder are not available from such insurers at commercially reasonable rates, the City Manager shall have the authority, in his or her sole and absolute discretion, to waive one or more of such requirements provided the proposed policies will adequately protect City's interests hereunder. Sec. 306.3, P3 Per SDC's broker (Cavignac) the only insurance carriers offering GL coverage for the nature of this risk profile all operate on a non -admitted basis. Due to the limited scope of the next 12 months, relatively small premium earned and the fact that the project profile will ultimately include residential risk elements, our options are significantly limited. On the advice of Cavignac, SDC requests that carriers with an AM Best rating of A -VII or greater should be deemed acceptable. SDC's proposal is as follows: Insurance Company: Colony Insurance Company Colony operates on a non -admitted basis in California. Colony is authorized to do business in California and maintains an AM Best Rating ofA-XII. 1 SDC is not proposing to waive this requirement, it is merely inapplicable in the instance of the Golf Course Phase. Should SDC in the future retain employees, it will comply with the terms of the PSDA for worker's compensation insurance. z SDC is not proposing to waive this requirement, it is merely inapplicable in the instance of the Golf Course Phase. SDC will provide evidence of the coverage above in lieu of commercial automobile liability insurance. Should, in the future, SDC acquire vehicles used at the Project, it shall comply with this requirement. 3 AC�R04DDATE 46. ---CERTIFICATE OF LIABILITY INSURANCE (MMIDD/YYYY) 9/7/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY QR 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 endorsementfsl. PRODUCER Cavignac & Associates 450 B Street, Suite 1800 San Diego CA 92101E CONTACT NAME;Certificate Department PHONE 619-744-0574 FAX 619-234-8601 rArc NQ) -1 -No,.EU- -M ss. certificates@cavignac.comIL INSURER'S) AFFORDING COVERAGE NAIC # INSURER A :Colony Insurance Company COMMERCIAL GENERAL LIABILITY INSURED SILVDEV-01 SilverRock Development Company, LLC c/o The Robert Green Company 3551 Fortuna Ranch Rd. Encinitas CA 92024 INSURER B : 103GL001844800 INSURER C :• `(MM/DD/YYYY) 6/12/2018 INSURERD: $1,000,000 INSURER E: $100,000 INSURER F : 1855346175 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 LTR TYPE OF INSURANCE ADM INSD SUHR WVD POLICY NUMBER mit? EFF- IMM/DD/YYYY) FOLIC'? EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 103GL001844800 6/12/2017 `(MM/DD/YYYY) 6/12/2018 EACH OCCURRENCE $1,000,000 PREMISESfE.gotZurrenee) $100,000 CLAIMS -MADE n OCCUR MED EXP (Any one person) 85,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000 000 GEN'L AGGREGATE LIMIT APPLIES POLICY n PRO- JECT OTHER: PER: LOC PRODUCTS - COMP/OP AGG 82,000.000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — ---- — SCHEDULED AUTOS NON -OWNED AUTOS COMBINEDSiNL,LEL1MIT _ (Ea edWdenI) -, BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) $ -PROPERTY DAMAGE (PeracGMerllN $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE [1 OFFICER/MEMBER EXCLUDED (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PEROTH- STATUTE I ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it mo e space is requi ed) RE: IMPROVEMENTS TO ARNOLD PALMER GOLF COURSE AT SILVERROCK RESORT IN LA QUINTA, CA. Additional Insured coverage applies to General Liability for THE CITY OF LA QUINTA per policy form, Waiver of subrogation applies to General Liability per policy form. If the insurance company elects to cancel or non -renew coverage for any reason other than nonpayment of premium Cavignac & Associates will provide 30 days notice of such cancellation or nonrenewal. CERTIFICATE HOLDER CANCELLATION CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 RECEIVED SEP 072017 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. gAlv CITY OF LA QUINTA ouTNORIZEDREPRESENTAT VE CITY CLERK DEPARTMENT' © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD OgivtaWn ATINUti A„) 0,0 V110 Tlr!1t�A`i3L3-�1f3 103 GL 0018448-00 ENDT. #002 EFF: 09/07/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES POLICY NUMBER 103 GL 0018448-00 POLICY CHANGES EFFECTIVE 09/07/2017 COMPANY Colony Insurance Company NAMED INSURED SilverRock Development Company, LLC AUTHORIZED REPRESENTATIVE Craig Comeaux COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY COVERAGE PART CHANGES In consideration of the premium charged, it is understood and agreed that the policy is amended as follows: ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION, Form CG2010-0413, City of La Quinta, is added to the policy. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS, Form CG2037-0413, City of La Quinta, is added to the policy. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED IL 12 01 11 85 Authorized Representative Signature Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 103 GL 0018448-00 ENDT. #001 EFF: 09/07/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY POLICY CHANGES POLICY NUMBER 103 GL 0018448-00 POLICY CHANGES EFFECTIVE 09/07/2017 COMPANY Colony Insurance Company NAMED INSURED SilverRock Development Company, LLC AUTHORIZED REPRESENTATIVE Craig Comeaux COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY COVERAGE PART CHANGES In consideration of an additional premium of $250.00, it is understood and agreed that the policy is amended as follows: WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US, Form CG2404, City of La Quinta, is added to the policy. Note: Premium of $250.00 is flat and fully earned. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED IL 12 01 11 85 California Premium: Non -Taxable Fees: Taxable Fees: Surplus Lines Tax: Stamping Fee: 250.00 50 7.50 Authorized Representative Signature Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 103 GL 0018448-00 ENDT. #002 EFF: 09/07/2017 POLICY NUMBER: 103 GL 0018448-00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of La Quinta As designated in written contract with Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your beha If; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2of2 103 GL 0018448-00 ENDT. #002 EFF: 09/07/2017 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 CG 20 10 04 13 103 GL 0018448-00 ENDT. #002 EFF: 09/07/2017 POLICY NUMBER: 103 GL 0018448-00 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of La Quinta As designated in written contract with Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1 1 103 GL 0018448-00 ENDT. #001 EFF: 09/07/2017 COMMERCIAL GENERAL LIABILITY QG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of La Quinta Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Declaration Regarding California Workers' Compensation You are required to complete this form because you have not filed a certificate regarding workers' compensation insurance with City of La Quinta. California law requires all employers to carry workers' compensation insurance, even if they have only one employee. If you do not know whether you are required to carry workers' compensation insurance, find out by contacting the California Department of Industrial Relations ("DIR"). Information is also available on the DIR's website at http:l/www.dir.ca.Rov. You should also consult with your attorney, insurance agent or broker, or carrier regarding the specifics of your situation and your options. If you are subject to the Workers' Compensation Laws of California, you must promptly file a certificate of Workers' Compensation Insurance with City of La Quinta. If you have a certificate of self-insurance from the DIR, you must file that certificate with City of La Quinta. When completing this form, remember that the term "employee" includes clerical persons as well as any other persons employed by your company including drivers. ACKNOWLEDGMENT r(initial) California Labor Code § 3700 requires employers to carry workers' compensation insurance or to obtain a certificate from the Director of Industrial Relations demonstrating that the employer is self-insured. California Labor Code § 3700.5 makes it a criminal offense for an employer to fail to secure compensation as required by the workers' compensation provisions of the Labor Code. Violation of Labor Code § 3700 is punishable by a fine of up to $10,000 and/or imprisonment for up to one year. ne 0{ (initial) California Labor Code § 3710.1 provides that where an employer fails to provide compensation required under § 3700, the Director of the Department of Industrial Relations shall issue a stop order, prohibiting the employer from using employee labor until such time as the employer complies with the provisions of § 3700. Labor Code § 3710.2 makes it a criminal offense to disregard such stop orders. (initial) I acknowledge that if evidence is found that contradicts this declaration, City of La Quinta will promptly notify all relevant state agencies to ensure full insurance compliance required by Workers' Compensation Laws of California. (initial) I understand that California Labor Code § 3700 et seq. requires employers to provide workers' compensation insurance coverage for any employees of my business. I hereby warrant that this business is exempt from the California Labor Code provisions regarding workers' compensation insurance because it has no employees. (initial) I agree to hold City of La Quinta and its officers, officials, employees, and agents harmless for Toss or liability which may arise from the failure of my business to comply with the laws of the State of California regarding workers' compensation insurance. (initial) If I hire employees in the future, I will immediately notify City of La Quinta and provide a certified Workers' Compensation certificate to the City. CERTIFICATION I (we) certify under penalty of perjury, under the laws of the State of California, that I (we) have read and understood the above stated requirements regarding Workers' Compensation and that I(we) am (are) in compliance. I(we) certify that the forgoing is true and correct. Executed this 30th day of August 2017 at Encinitas R California Signature of Declarant Robert S. Green, Jr. Print Name of Declarant SilverRock Development Company Print Name of Company Policy Summary Automobile Policy 1. Named Insured ROBERT GREEN 1440 AKITA LN ENCINITAS, CA 92024-5701 TRAVELERS .1 Your Agency's Name and Address DOLE & SONS INC PO BOX 400 BONITA, CA 91908-2000 Your Insurer TRAVELERS PROPERTY CASUALTY INSURANCE COMPANY ONE TOWER SQUARE, HARTFORD, CT 06183 Your Auto Policy Number 995381351 203 1 Your Account Number 995381351 For Policy Service For Claim Service For Roadside Assistance 1-619-475-5200 1-800-252-4633 1-800-252-4633 2. Premium Your Total Premium for the Policy Period is $4,663. The policy period is from August 19, 2017 to February 19, 2018 12:01 A.M. STANDARD TIME at your address shown in Item 1. 3. Your Vehicles 1. 1990 PORSE 911 CARRER 2. 2013 FORD EDGE SEL 3. 2014 FORD F-150 SUPE 4. 2017 JEEP CHEROKEE T Identification Numbers WP0AB2960LS450824 2FMDK3J91 DBA74599 1FTFW1CT1EKE01282 1 C4PJMBS4HW615869 4. Coverages, Limits of Liability and Premiums Insurance is provided only where a premium entry is shown for the coverage. The premium entry "Ince' or "Pkg" means the premium charge is included in the premium for another coverage or a package. A. Bodily Injury $250,000 each person $500,000 each accident B. Property Damage $100,000 each accident C. Medical Payments $2,000 each person D1. Uninsured Motorists Bodily Injury $250,000 each person $500,000 each accident PL -50014 (03-12) 476/OVE143 VEHICLE 1 VEHICLE 2 VEHICLE 3 VEHICLE 4 90 PORSE 911 CARRER 13 FORD EDGE SEL 14 FORD 17 JEEP F-150 SUPE CHEROKEE T $273 $302 $733 $101 $195 $438 $13 $13 $26 $61 $52 $68 $328 $326 $31 $72 Page 1 of 4 TRAVELERS) 4. Coverages, Limits of Liability and Premiums (continued) Insurance is provided only where a premium entry is shown for the coverage. The premium entry "Incl" or "Pkg" means the premium charge is included in the premium for another coverage or a package. VEHICLE 1 VEHICLE 2 VEHICLE 3 VEHICLE 4 90 PORSE 911 CARRER 13 FORD EDGE SEL 14 FORD 17 JEEP F-150 SUPE CHEROKEE T E. Collision Actual Cash Value less $500 deductible $217 $233 $477 $456 T. Waiver of Collision Deductible $2 $2 $4 $4 F. Comprehensive Actual Cash Value less $500 deductible Loan or Lease Gap Coverage See Endorsement E1 NCW01 (10-13) $15 $42 $84 $46 $25 Roadside Assistance Coverage See Endorsement E1 RCW02 (10-13) Up to 15 mites per disablement $6 $6 $6 $6 Subtotal for your vehicle(s): $688 $845 $1,836 $1,294 Total Premium for This Policy: CA Fraud Prevention Fee: $4,663 $1.76 Total Premium for this Policy including assessment: $4,664.76 This is not a bill. You will be billed separately for this transaction. 5. Information Used to Rate Your Policy Discounts and Programs Multi -Policy Discount Group Program Driver Safety Education Discount RYAN Good Student Discount ROBERT WARREN Student Away at School Discount ROBERT Superior Good Driver Discount WENDY Good Driver Discount ROBERT ROBERT Months Clean Discount 90 PORSE Enrollment Discount 17 JEEP Certified Mileage Program PL -50014 (03-12) 476/OVE143 13 FORD WARREN RYAN ROBERT WENDY 14 FORD 17 JEEP Page 2 of 4 Named Insured ROBERT GREEN Policy Period August 19, 2017 to February 19, 2018 TRAVELERSJ Policy Number 995381351 203 1 Issued On Date August 1, 2017 5. Information Used to Rate Your Policy (continued) Your Total Savings Reflected in Your Total Premium: $2,528 Driver and Vehicle Details Drivers 1. ROBERT 2. WENDY 3. ROBERT 4. RYAN 5. WARREN Vehicles 1. 90 PORSE 911 CARRER 2. 13 FORD EDGE SEL 3. 14 FORD F-150 SUPE 4. 17 JEEP CHEROKEE T Mileage Information: Your policy is enrolled in the Certified Mileage Program. This means we will attempt to collect the necessary odometer readings to calculate a verified annual mileage for your vehicle(s). If we successfully obtain the necessary information to calculate a verified annual mileage, your vehicle's mileage type is shown below as "Certified". If we are unable to obtain the necessary information, your vehicle's mileage type is shown below as "Estimated". If your vehicle is new to you, purchased within 90 days of this policy's effective date, your mileage type is shown below as "Enrollment". Date of Gender Marital License Birth Status Status 05-28-1960 Male Married Licensed 01-04-1967 Female Married Licensed 07-19-1996 Male Single Licensed 04-14-1998 Male Single Licensed 06-27-1999 Male Single Licensed Use of Vehicle Pleasure Commute Commute Pleasure Location of Vehicle ENCINITAS, CA ENCINITAS, CA ENCINITAS, CA ENCINITAS, CA Years of Driving Exp. 41 34 5 3 2 Vehicles 1. 90 PORSE 911 CARRER 2. 13 FORD EDGE SEL 3. 14 FORD F-150 SUPE 4. 17 JEEP CHEROKEE T Annual Mileage 12,000 14,621 22,296 6,000 Mileage Type Estimated Certified Certified Enrollment The following accidents and/or traffic violations are reflected in your total premium: Driver ROBERT RYAN Incident Violation Violation Violation Date 04-19-16 12-09-15 07-24-15 If any of the information above is incorrect or has changed, please notify your Travelers representative immediately. 6. Other Information Additional Insured — See Endorsement E1CCW02 (10-13) 17 JEEP CHEROKEE T VIN # 1C4PJMBS4HW615869 PL -50014 (03-12) 476/0VE143 ALLY BANK LEASE TRUST PO BOX 8105 COCKEYSVILLE, MD 21030-8105 Page 3 of 4 6. Other Information (continued) Lienholder/Loss Payees Information 13 FORD EDGE SEL VIN # 2FMDK3J91 DBA74599 17 JEEP CHEROKEE T VIN # 1C4PJMBS4HW615869 TRAVELERS CAPITAL ONE AUTO FINANCE PO BOX 390907 MINNEAPOLIS, MN 55439-0907 LOAN # ALLY BANK LEASE TRUST PO BOX 8105 COCKEYSVILLE, MD 21030-8105 LOAN # Policy Coverage Sections and Endorsements That Form a Part of This Policy: GO1CA00 (06-15) LO1 CA00 (06-15) MO1 CW01 (10-13) U01 CA00 (06-15) P01 CA00 (06-15) SO1 CW01 (10-13) E1CCW02 (10-13) E1ICA00 (06-15) E1 NCW01 (10-13) E1 RCW02 (10-13) E1YCA00 (06-15) E2PCA00 (06-15) General Provisions Section Liability Coverage Section Medical Payments Coverage Section Uninsured Motorists Coverage Section Damage To Your Auto Coverage Section Signature Page Additional Insured Limited Mexico Coverage Loan or Lease Gap Coverage Roadside Assistance Coverage Personal Vehicle Sharing Exclusion Broadened Coverage Endorsement Online Policy Summary as of August 1, 2017 PL -50014 (03-12) 476/OVE 143 Page 4 of 4 USAA CASUALTY INSURANCE COMPANY PAGE 7 ADDL INFO ON NEXT PAGE MAIL MCH -M -I RENEWAL OF 1 vzoi (A Stock Insurance Company) USAV 9800 Fredericksburg Road - San Antonio, Texas 78288 CALIFORNIA AUTO POLICY State 07108 0 9 va, POLICY NUMBER 00381 9 3 06 C 7101 6 CA ' 8$2$ 8$158SI LXir IOJCYPERKD : (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE JUL 07 2017 TO JAN 07 2018 OPERATORS (ATTACH TO PREVIOUS POLICY) Named Insured and Address 01 JOHN P GAMLIN 03 CLAUDIA G SALVATIERRA-GAMLIN 07 SOFIA A GAMLIN JOHN P GAMLIN 79625 RANCHO SAN PASCUAL LA QUINTA CA 92253-8460 Description of Vehicle Vehicle(s) VEH USE' �e-c YEAFJ TRADE NAME MDDEL BODYTYPE �� IDENTIFICATION NUMBER SYM leis 07 73 MG B ROADSTER 0 GHN5UD310915G P 08 04 LEXUS SC 430 CONV CONV 12000 JTHFN48Y040055968 P 09 05 SUBARU FORESTER 4 DOOR 15000 JF1SG696X5H715297 P The Veh'cle(s) described herein is principally garaged at the above address un'ess otherwise Stated.?' WC'Wat rodiaal:B=Business F=Famr,P=Pleasure CA 92253-8460 VEH 07 LA QUINTA CA 92253-8460 VEH 09 LA QUINTA VEH 08 LA ()UINTA CA 92253-8460 This policy provides ONLY those coverages where a premium is shown below. The limits shown may be reduced by policy provisions and may not be combined regardless of the number of vehicles for which a premium is listed unless specificall reauthorized elsewhere in this policy. COVERAGES LIMITS OF LIABILITY VEH 07 6 -MONTH VEH 08 6 -MONTH VEH 09 6 -MONTH VEH (°ACV" MEANS ACTUAL CASH VALUE) D=DED PREMIUM O'DED PREMIUM D=DED PREMIUM D=OED PREMIUM AMOUNT $ AMOUNT $ AMOUNT $ r1MOUNT $ PART A - LIABILITY BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 64.59 68.73 164.43 PROPERTY DAMAGE EA ACC $ 100,000 47.30 54.17 139.79 PART B - MEDICAL PAYMENTS EA PER $ 5,004 6.25 5.27 14.60 PART C - UNINSURED MOTORISTS BODILY INJURY EA PER $ 100,000 EA ACC $ 300,000 31.22 36.74 56.53 WAIVER OF COLL DEDUCTIBLE 6.50 7.65 8.22 PART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 500 7.59D 500 49.411D 500 38.16 COLLISION LOSS ACV LESS D1000 25.14D1000 145.41JD 500 231.80 VEHICLE TOTAL PREMIUM 188.59 367.38 653.53 6 MONTH PREMIUM $ 1209.50 PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL, STA EMENT PO FOL,LOW. ADDITIONAL MESSAGE(S) - SEE FOLLOWING PAGE(S) ENDORSEMENTS: ADDED 07-07-17 - NONE REMAIN. IN EFFECT(REFER TO PREVIOUS POLICY)- A400CA(03) A100CA(05) RSGPCW(01) AOASA(01) A099(01) 5100CA(01) INFORMATION FORMS: CADS(03) 40CA(01) 13580(03) ridi RMF38000N 1 1[E)8 RMM41000N '09 RSFO2000V 1 W E In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas, on this date JUNE 6, 2017 5000 C 05-12 53383-05-12 Deneen Donnley, Secretly S. Wayne Peacock, President