Insurance Certificates 2017/18 ClearSource FinancialAQ® DATE(MM/DD/YYW)
CERTIFICATE OF LIABILITY INSURANCE 06/06/18
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 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 endorsement(s).
PRODUCER (CONTACT
NAME:
FRANK VITALE INSURANCE AGENCY PHONE g31 462-9222FAX
LA/C. No. EXt): ) (A/C, No): (831) 4 62 — 92 9 9
4067 Cory St ADDRIESS:FVltale 99@gmail . oom
Soquel, CA 95073 INSURER($) AFFORDING COVERAGE NAICN
INSURERA: PHILADELPHIA INDEMNITY INS CO 18058
INSURED CLEARSOURCE FINANCIAL CONSULTING INSURER B : TRAVELERS PROPERTY & CASUALTY 25674
7960 B SOQUEL DR, STE 363 INSURERC:
APTOS , CA 95003 INSURER D :
I INSURER E :
INSURER F.
COVERAGES 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDD/YYYY) (MWDD/YYYY) I LIMITS
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE CI OCCUR
A _
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY CI PECT RO- C LOC
J
OTHER:
AUTOMOBILE LIABILITY
ANYAUTO
A -OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
UMBRELLA LIAB k_� OCCUR
Y Y PHSD1302245
PHSD1302245
12/9/2017 12/9/2018
12/9/2017 12/9/2018
EACH OCCURRENCE $
DAMAGE I HENIEU
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE Is
PRODUCTS - COMP/OP AGG $
$
COMBINED SINGLE LIMI 1 $
(Ea accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident)( $
PROPERTY DAMAGE $
(Per accident)
�$
EACH OCCURRENCE Is
1,000,000
50,000
5,000
1,000,000
3,000,000
1,000,000
1,000,000
EXCESS LIAB CLAIMS -MADE I AGGREGATE $
DED I RETENTION $ 1 $
WORKERS ONi ENSATIONLR
AND EMPLOYERS' LIABILITY X STATUTE I ER"
IN
ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ Y UB-8J345908-18-42 1/1/2018 1/1/2019 I E.L. EACH ACCIDENT $ 1,000,000
B OFFICERIMEMBER EXCLUDED? NIA
(Mandatory in NH) I E.L. DISEASE - EA EMPLOYE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ 1,000,000
AGGREGATE $2,000,000
A PROFESSIONAL LIABILITY PHSD1302245 12/9/2017 12/9/2018 OCCURENCE $1 , 000 , 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
PER CO "A" BLANKET ADDITIONAL INSURED, PRIMARY & WAIVER OF SUBROGATION POLICY ELITE ENDORSEMENT FORM
PI—BP-001 ATTACHED, AND PER CO "B" WAIVER OF SUBROGATION ENDORSEMENT WC0403 06 01 ATTACHED, THE CITY
OF LA QUINTA,ITS OFFICERS,EMPLOYEES,CONTRACTORS, SUBCONTRACTORS AND AGENTS ARE NAMED AS ADDITIONAL
INSURED WITH REGARDS TO THE INSUREDS JOB: FEE UPDATE / COST OF SERVICE ANALYSIS.
*10 DAY NOTICE OF CANCELLATION FOR NON—PAYMENT OF PREMIUM APPLIES.
CERTIFICATE HOLDER CANCELLATION
CITY OF LA QUINTA
ATTN: MONIKA RADEVA, ACTING CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
78495 CALLE TAMPICO ACCORDANCE WITH THE POLICY PROVISIONS.
LA QUINTA CA, 92253
AUTHORIZED REPRESENTArr
I
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD
PI-BP-001 (9/05)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESSOWNERS POLICY -ELITE ENHANCEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM
It is understood and agreed that the following extensions only apply in the event that no other specific
coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies,
the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this
policy.
Throughout this endorsement the words "you" and "your" refer to the Named Insured shown in the
Declarations. The words "we", "us" and "our" refer to the Company providing this insurance.
Part 1: Property Coveraae Enhancements:
The following amendments are a part of the BUSINESSOWNERS SPECIAL PROPERTY
COVERAGE FORM:
1. Increased Glass Limits
Section A. Coverage, item 4.b. is replaced by:
b. With respect to glass (other than glass building blocks) that is part of the interior of a building
or structure, or part of an outdoor sign, we will not pay more than $3,000 for the total of all
loss or damage in any one occurrence.
This Limitation does not apply to loss or damage by the "specified causes of loss", except
vandalism.
2. Increased Fire Department Service Charge
Section A. Coverage, item 5.c. is replaced by:
c. Fire Department Service Charge
When the fire department is called to save or protect Covered Property from a Covered Cause
of Loss, we will pay up to $3,000 for your liability for fire department service charges:
(1) Assumed by contract or agreement prior to loss; or
(2) Required by local ordinance.
3. Reduced Waiting Period and Longer Duration for Civil Authority Coverage
Section A. Coverage, item 5.i. is replaced by:
Civil Authority
We will pay for the actual loss of Business Income you sustain and necessary Extra Expense
caused by action of civil authority that prohibits access to the described premises due to direct
physical loss of or damage to property, other than at the described premises, caused by or
resulting from any Covered Cause of Loss.
The coverage for Business Income will begin 48 hours after the time of that action and will
apply for a period of up to three consecutive weeks after coverage begins.
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PI-BP-001 (9/05)
The coverage for necessary Extra Expense will begin immediately after the time of that action
and ends:
(1) 5 consecutive weeks after the time of that action; or
(2) When your Business Income coverage ends; whiche✓er is later.
The definitions of Business Income and Extra Expense contained in the Business Income and
Extra Expense Additional Coverages also apply t0 this Civil Authority Additional Coverage.
The Civil Authority Additional Coverage is not subject to the Limits of Insurance.
4. Broadened Personal Property Coverage
Section A. Coverage, item 1.b., the first paragraph is replaced by:
b. Personal Property located in or on the buildings at the described premises or in the open (or
in a vehicle) within 1,250 feet of the described premises, including:
5. Increased limits for Personal Property Off Premises
Section A. Coverage, item 6.b. is replaced by:
b. Personal Property Off Premises
You may extend the insurance that applies to Business Personal Property to apply to covered
Business Personal Property, other than "money" and "securities", "valuable papers and
records" or accounts receivable, while it is in the course of transit or temporarily at a premises
you do not own, lease or operate. The most we will pay for loss or damage under this
Extension is $10,000.
6. Increased limits for Outdoor Property
Section A. Coverage, item 6.c. is replaced by:
c. Outdoor Property
You may extend the insurance provided by this policy to apply to your outdoor fences, radio
and television antennas (including satellite dishes), signs (other than signs attached to
buildings), trees, shrubs and plants, including debris removal expense, caused by or resulting
from any of the following causes of loss:
(1) Fire;
(2) Lightning;
(3) Explosion;
(4) Riot or Civil Commotion; or
(5) Aircraft.
The most we will pay for loss or damage under this Extension is $5,000, but not more than
$1,000 for any one tree, shrub or plant.
7. Fire Extinguisher Recharge
Section A. Coverage, item 6. Coverage Extensions will also include:
You may extend the insurance provided by this coverage form to cover expenses you incur to
recharge portable fire extinguishers, dry chemical, carbon dioxide, or liquid automatic fire
extinguishing systems and the cost of resetting automatic fuel shut-off connections, if any of the
above are discharged to fight a fire or are discharged due to a mechanical malfunction.
The most we will pay for loss or damage under this extension is $3,000.
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PI-BP-001 (9/05)
No deductible shall apply to this coverage.
8. Business Income Enhancement
Section A. Coverage, item 5. Additional Coverages, section f. Business Income is amended as
follows:
The reference to "60 days" as the limitation on payroll expenses is replaced by "365 days."
9. Lock Replacement
Section A. Coverage, item 6. Coverage Extensions will also include:
You may extend the insurance provided by this coverage form to cover necessary expense to repair
to replace exterior or interior door locks of a covered building:
a) If your door keys are stolen in a covered theft loss; or
b) When your property is damaged and your door keys are stolen by the burglars.
The most we will pay under this extension of $250 for any one occurrence.
10. Removal of Sewer Backup Exclusion
Section B. Exclusions, item g(3) is amended to include:
Backups of sewers will not be excluded, but the most we will pay for such losses is $500 in the policy
period.
Part 2: Liability Coveraae Enhancements:
The following amendments are a part of the BUSINESSOWNERS LIABILITY COVERAGE FORM:
1. Medical Payments
If Medical Payments Coverage (Coverage A.2.) is not otherwise excluded from this Coverage Part:
The Medical Expense Limit is changed subject to all the terms of Limits Of Insurance (Section D) to
the greater of:
a. $10,000; or
b. The Medical Expense Limit shown in the Declarations of this Coverage Part.
2. Supplementary Payments
In the Supplementary Payments — (Coverage A.1.d.):
1. The limit for the cost of bail bonds (item (2)) is changed from $250 to $500; and
2. The limit for loss of earnings (item (a)) is changed from $250 a day to $500 a day.
3. Blanket Additional Insureds
Who is An Insured (Section C) is amended to include the following, but only for liability arising out of
the negligence of the Named Insured:
Each of the following is also an Insured:
a. any Contractor, including contracting governmental entities, who hires you as their
subcontractor;
b. any person or organization who has an ownership interest in you;
c. any lessor of leased equipment, who rents equipment to you, but only with respect to
liability arising out of the maintenance, operation, or use by you, provided however that this
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PI-BP-001 (9/05)
item c. will not apply to (1) any occurrence which takes place after the equipment lease
expires; nr (2) "Bodily Injury" or "Property Damage" arising out of the negligence of the
lessor or contractor engaged to operate the leased equipment; and
d. any owner, mortgagor, lessor, landlord, condominium association or manager of a
premises leased by you, but only for "occurrences" that take place while you occupy the
premises, provided however that this item d. will not apply to structural alterations, new
construction, or demolition operations; and
With regard to parties applicable under items a. through d. above, the Insurer and the Named
Insured agree to waive rights of recovery, as provided within the policy.
Nothing contained in this section C. shall serve to nullify matters excluded under section B. of the
policy.
4. Bodily Injury - Mental Anguish
The definition of "bodily injury" is changed to read:
"Bodily Injury":
a. Means bodily injury, sickness or disease sustained by a person, and includes mental anguish
resulting from any of these; and
b. Except for mental anguish, includes death resulting from the foregoing (item a. above) at any
time.
5. Liberalization
If we revise this endorsement to provide more coverage without additional premium charge, we will
automatically provide the additional coverage to all endorsement holders as of the day the revision is
effective in your state.
6. Employee Indemnification Defense Coverage
Under SUPPLEMENTARY PAYMENTS — COVERAGES A.1.d., the following is added:
(8) We will pay on your behalf defense costs incurred by an "employee' in a criminal proceeding,
provided, however that you must have a prior written agreement with such "employee"
whereby you agree to indemnify the "employee" for such defense costs, and the agreement
includes a provision for repayment of defense costs in the event of an adverse judgment. The
most we will pay for any "employee" who is alleged to be directly involved in a criminal
proceeding is $2,500 regardless of the number of employees, claims or "suits' brought or
persons or organizations making claims or bringing "suits."
7. Amendment of Aggregate Limit
SECTION DA. — Aggregate Limits, item B is replaced by:
b. All other injury or damage, including medical expenses, arising from all 'occurrences' during
the policy period is three times the Liability and Medical Expenses limit. This limitation does
not apply to "property damage" to premises while rented to you or temporarily occupied by
you with permission of the owner, arising out of fire or explosion.
8. Amendment to Watercraft Exclusion
Part B- Exclusions, item g.(2)(a) is amended by the following:
The phrase "less than 26 feet' is replaced by "less than 51 feet."
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PI-BP-001 (9/05)
Part 3: Amendment of Conditions:
1. Other provisions of the policy notwithstanding, this policy will be primary for all losses covered herein,
and the existence of other insurance will not serve to reduce our obl;gation.
2. You will have the right to waive our rights of recovery prior to a loss with respect to any party. This must
be done in writing to affect our rights.
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TRAVELERS J� WORKERS COMPENSATION
AND
ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY
HARTFORD CT 06183
ENDORSEMENT WC 04 03 06 (01) — 006
POLICY NUMBER: UB-8J345908-18-42-G
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT-CALIFORNIA
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 5 . 00% OF THE CALIFORNIA WORKERS'
COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
CITY OF LA QUINTA FEE UPDATE/COST OF SERVICE ANALYSIS
78495 CALLE TAMPICO
LA QUINTA, CA 92253
DATE OF ISSUE: 05-08-18 ST ASSIGN: Page 1 of i