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Insurance Certificates 2013/14 Pacific West Industries, Inc10VV g10' AC.O,r�,O® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 11/0712o13 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 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) roust 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 Pynn insurance Agency, LLC 42103 Rio NedD Unit 107 Temecula CA 92590 CONTACT Mari Drewry PHONE FAX E <I), (951) 239-0038 L/C tic. (951) 296-9929 nooREss: Mad@pynil nstiranceagency.com IirSURER(5) AFFORDING COVERAGE HAIC it INSURER A:AmTrusl International Underwriters, Ltd. INSURED PACIFIC WEST INDUSTRIES, INC 4085 E LA PALMA AVE STE B ANAHEIM CA 92807-1702 INSURER B : INSURERc- National Union Fire Ins. Co. of Pittsburgh, PA. INSURERD: INSURER E: 1 INSURERF., COVFR41117S CFRTIFiCATE 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. TYPE OF INSURANCE L AUUILTR )i POLICY EFF MMIDDIYYYY POLICY EXP rAMIDOIYYYY LIMITS A GENERALUABILITY X COMMERCIAL GENERAL LiAB CLAIMS.MADE OCCUR Y Y XN193207301 11101/2013 11101/2014 EACH OCCURRENCE S 1,000,000 -DAWAGE'UREFTI'M PREMISES 100,000ILITY S MED EXP (Any ano person) S 5,000 PERSONAL& ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X1 POLICY ngwi El tooI PRODUCTS -COMPIOPAGO S 2,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTNOROWNED _ HIREDAUTOS AUTOS COrABINEO SINGLE LIMIT IEnncctderA) S BODILY INJURY (Por parson) S BODILY INJURY (Par occkleni) S PPRoOPERTY D AGE 5 S C X UMBRELLALIAB EXCEssUAB OCCUR CLAIMS -MADE EBU-023518230 1110112013 11/0112014 EACH OCCURRENCE S 1,000,000 AGGREGATE S 1,000,000 DED RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIE'TOFWARTNERIEXECUTNE ❑ OFFICEMMEMBER EXCLUDED? (Mandatory in NH) U yos, describe under DESCRIPTION OF OPERATIONS below NIA WC5TATU• OTH- lMJIS E.L. EACH ACCIDENT 5 E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE- POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allach ACORO101,Addillonal Ramarks Schoduto,lrmoroepacnieraqulrad) City of La Quinta Is named Additional Insured per the attached endorsement *130 Day Notice of Cancellation shall be afforded the Certificate Holder" City of La Quinta P.O. Box 1604 La Quinta, CA 92247 25 (20101051 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 c.Y OAa C 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 112/12/2013 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ROTHSTEIN INSURANCE AGENCY 1833 Portola Road Ste A2 Ventura, CA 93003 PHONE KC, No Ext: 805 648-6595 FAX No): (805) 435-1599 ADDRESS: barry@ rinsurance . net INSURER(S) AFFORDING COVERAGE NAICS License#:OE68747 INSURER A: Hartford Casualty Ins. Co. INSURER B: INSURED Kevin Marquardt Pacific West Industries, Inc. INSURER C: 4085 E . La Palma Ave . , Suite B INSURER D: Anaheim, CA 92807 714 630-4440 1 INSURER E: INSURER F: -----"-"'--"' rNCVIJIIJIV IVUn/IDr—M. 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 S lJaR LTR INSR WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE D OCCUR MED EXP (Anyone person) $ PERSONAL BADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOG $ AUTOMOBILE LIABILITY Ea accident $ ANYAUTO BODILY INJURY (Per person) $ ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND WC STATU OTH- X EMPLOYERS' LIABILITY Y/N TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER N/A 72WECEQ3302 1/17/2013 1/17/2014 EXCLUDED? (Mandatory in NH) If yes, describe under E.L. DISEASE- EA EMPLOYEE $ 1,000,000 DISEASE -POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS below IE.L. IT DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (AftachACORD 101,Additional Remarks Schedule, if morespaceis required) Proof of Insurance City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 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 (9 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XN103207301 COMMERCIAL GENERAL LIABILITY NXGL1890511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. D. The following are added to SECTION V — DEFINITIONS: "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: Primary Wording With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "you work" done under a contract with that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material.of Insurance Services Office, Inc., with its permission -mai-1a 14.1.2i34p PA CERTIFICATE OF INSURANCE. SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE: HOLDER NAMED BELOW WILL NOT BE CANCELED OR OTHERWISE •TERMINATED: WITHOUT GIVING W DAYS PRIOR:. WRITTEN . NOTICE TO THE CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS, CERTIFICATE BE VALID MORE THAN; 30 DAYS:,FROM . THE: DATE WRITTEN. THIS:CERTIFICATE.OF INSURANCE DOES NOT CHANGE'THE COVERA'G'E PROVIDED BY ANY POLICY DESCRIBED BELOW: _ This certifies that; STATEFARM MUTUALAUTOMOBILE INSURANCE'COMPANY of Bloomington, Illinois - STATE FARM FIRE AND.OASUALTY COMPANY'of gh ...gtort. Illinois [] STATE FARM COUNTY MUTUALINSURANCE COMPANY OF TEXAS of Dallas, Texas or STATE FARM INDEMNITY COMPANY -of Bloomington, lllinois has coverage in force for the following Named Insured -as shown below: NAMED INSURED Pacific West- industries INC_. ADDRESSOFNAMED.1'NSURED:, 4085 E. La: Palma .Ave S.te,33 Anaheim, CA 92807. POLICYNUMBER 245 8088-F01-55 :. 234:6785 F01.55 EFFECTIVE DATE, OF POLICY _. 12/01f 13.-06/0_/14 11/01/13-05/01/`14 :. 77 DESCRIPTION OF 11 Che-,t Silver"ad: 08 Chevy Express VEHICLE (Including VIN). 1GB0CVCG4BF158d34 1GCGC-25Rk81229=.62 LIABILITY COVERAGE . ®:YES : ❑ NO :. ®-YES ❑; NO ❑. YES ❑ NO: E] YES ❑ NO LIMITS OF LIABILITY a. Bodily Injury Each. Person, $100000.0 $100.000 Each Accident s000.000 $1000000 b: Property Damage - Each Accident $ og0o;0o S1000000. c. Bo.dily Injury & Property Damage Single Limit: . Each.Accident - PHYSICAL DAMAGE YES - ❑ NO ® YES ❑ NO ❑ YES ❑ NO ❑YES ❑! NO COVERAGES a. Corn rehenslve. $' 10oo Deductible. $ 1000 Deductible $ ;:Deductible $ Deductible Z'YES ❑ ND YES ❑ NO ❑YES ❑ NO ❑:YES [].NO b. Collision $.:1p00. _ Deductible $ 1000 Deductible:: $ Deductible $ Deductible EMPLOYERS NON -OWNED CAR LIABILITY COVERAGE. YES ❑ 1V0 ® YES [:]NO.. . ❑ YES ❑ NO ❑'YES. ❑ NO HIRED CAR LIABILITY COVERAGE YES . ❑ NO YES ❑` NO ElYES ElNO- DYES ❑ NO FLEET -COVERAGE'FOR ALL OWNED AND LICENSED YES:.❑❑ NO C] YES ❑ NO .. ❑,YES ❑ NO E1,YES _ El NO MOTOR.VEHICLES. 114 AGENT 55 8317 03/184 Signature of Authorize.' Representative Title Agent s Code. Number Date Name and Address of Certificate Holder Name and Address of Agent: - Citv of La Quirita Sz:-Le Fare insurance �"�ea Kea 7$N�5 1�f1�(�G 1 QIW��Cn7 Marty Mi_1er La QLir_ta, CFI 442 �-_-• - 2567 Camino.Lel:Fio S.o.4 1L2 -. 2263 San:Diego, Ca 92308 INTERNAL STATE FARM USE ON..LY, . ❑:Request permanent Certificate oF,Insurance::fo*r. Iia i b .ityi.coverage. . . . d `1224N.2 Rev: 0&t0-2004 'Request Cerbficate.Holderao be added as an Additional Insure a PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: CITY OF LA QUINTA Attn: City Clerk 78-495 Calle Tampico La Quinta, CA 92253 DOC # 2014-0206840 06/04/2014 04:11 PM Fees: $0.00 Page 1 of 2 Recorded in Official Records County of Riverside Larry W. Ward Assessor, County Clerk & Recorder "This document was electronically submitted to the County of Riverside for recording— Receipted by: MGREGSTON SPACE ABOVE FOR RECORDER'S NOTICE OF COMPLETION CITYWIDE PREVENTATIVE'MAINTENANCE IMPROVEMENTS CITY HALL BUILDING HVAC SYSTEMS 1 & 2 REPLACEMENT CITY OF LA QUINTA PROJECT 2013-13B CONTRACTOR: Pacific West Industries, Inc. Title of Document THIS AREA FOR RECORDERS USE ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION Exempt Recording Fees der Government Code Sections 6103 and 27383 NOTICE OF COMPLETION FILED BY THE CITY OF LA QUINTA, CALIFORNIA NOTICE IS HEREBY GIVEN: That the interest or estate stated in paragraph 3 herein in the real property herein described is owned by: The City of La Quinta, California, a Municipal Corporation, organized and incorporated pursuant to the laws of the State of California. 2. The City Clerk of the City of La Quinta is authorized and directed to execute, on behalf of said City, any and all Notices of Completion. 3. That the nature of the life of the stated owner, or if more than one owner, then of the stated owner and co -owners is: In Fee. 4. That on the 3RD day of June 2014, a work of improvement on the real property herein described was completed. . 5. The- public work improvement is described as follows: Citywide Preventative -- Maintenance Improvements and City Hall Building HVAC systems 1 and 2 Replacement. City Project 2013-13B. 6. The name of the contractor for said work of improvement was Pacific West Industries, Inc. 7. The property on which said public work of improvement was completed is in the City of La Quinta, County of Riverside, State of California,, and is described as follows: La Quinta City Hall. DATED: June 4, 2014 CITY OF LA QUINTA, CALIFORNIA BY: pwly��— TITLE: Susan Maysels, City Jerk STATE OF.CAL-IFORNIA 1 COUNTY OF RIVERSIDE ) I hereby certify that I am the City Clerk of the governing board of the City Council of the City of La- Quinta, the- political- subdivision which executed the foregoing notice- and on� whose behalf I make this verification: that I have read said notice, know its contents, and that the same is true. I certify under penalty of perjury that the foregoing is true and correct. Executed at La Quinta, California. SUSAN MAYSELS, City Jerk City of La Quinta, California