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Insurance Certificates 2018/19 Cuevas, Johnaca►eo' III CERTIFICATE OF LIABILITY INSURANCE °A 0/23/2018 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: It 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 endarsement(s). PRODUCER CONTACT ACT Program Support NAME: Veracity Insurance Solutions, LLC. laCNrio EV7c (844)-520-6991 _-1AlG;NeI: (801}-763-1374 260 South 2500 West, Suite 303 p�pD IRFCR; infolgaclinsurance.com Pleasant Grove UT 84062 INSURER(S)AFFORDING COVERAGE NAIC# Great American Alliance Insurance Co. 26832 INSURED John Cuevas 77535 California Drive Palm Desert CA 92211 INSURER c INSURER E: r %JCOArsM rGDTIGIr•ATG MI IMRFD- RFVI-Clrlhl ildI1YRFR• 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 A°OL SUUR POLCY EFF POLICYEXP LTR POLICY NUMBER MMIDDIYYYY MPWDD LIMITS GENERAL L]A13ILFTY EACH OCCURRENCE S 1,000,000 X DAMAGETO RENTED S 300.000 COMMERCIAL GENERAL LIABILITY r— r CLAIMS -MADE n OCCUR A I PREMISES. 11 .nwur 1 MED EXP (Anyone person) S 5,000 A PL1744466-AA09072OX 08/04/2018 08/04/2019 1,000,000 PERSONALBADVINJURY S GENERAL AGGREGATE S 2,000,000 S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG X I ?MICY ' PR T LOC ANIMAL BAILEE S AUTOMOBILE LIABILITY F_ F 'I COMe151NG�E LIMIT 15 ^ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY (Per accident)- S AUTOS AUTOS PROPERTY DAMAGE NON -OWNED HIREDAUTOS AUTOS ' 1 (Per accident) S UMBRELLA LIAB OCCUR IF EACH OCCURRENCE S ,F EXCESS LIAB CLAIMS -MADE, AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION WC STATU- OTH-� TORY LIMITS ER AND EMPLOYERS' LIABILITY YIN _ _ AN V PROPRIETOR/PARTNERIEXECUTIVE '� E L EACH ACCIDENT S OFFICE/MEMBER EXCLUDED? ❑ NIA (Mandatory In NHI E.L. DISEASE - FA EMPLOYEE S If yes, describe under p IDMI w E L DISEASE - POLICY LIMIT S FF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured - Designated Person or Organization (CG20 26, ED. 04 13) This insurance is primary and non-contributory t.crc I IrIi.F1I G nu�ucrc Christina Calderon/The City of La Quinta 78495 Calle Tampico La Quinta, CA92253 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (2014011 PL1744466-AA09072OX THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED 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): Per individual Certificate of Coverage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 26 (Ed. 04 13) 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. in the performance of your ongoing operations; or 2. in connection with your premises owned by or rented to you. 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 contractor 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. 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. Copyright, ISO Properties, Inc., 2012 Page 1 of 1 CG 20 26 (Ed. 04/13) PRO CG 20 01 (Ed. 04 13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARYAND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance avail- able to an additional. insured under your policy provided that: CG 20 01 (Ed. 04/13) (1) the Additional Insured is a Named Insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. Copyright, ISO Properties, Inc., 2012 Declaration of Sole Proprietor DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO John Cuevas Individual or Organization Name I declare for the purpose of inducing the City of La Quinta to go forward with any contracts awarded to John Cuevas as follows: I am the authorized representative of John Cuevas an independent contractor for the purposes of the California Workers' Compensation and Labor laws. This organization will hire no employees other than the parents, spouses, or children of its board members for work required for any bid or contract awarded to John Cuevas . All worked required will be performed personally and solely by me, other board members of the organization, their parents, spouses or children, or persons who perform voluntary service without pay to the organization. If, however, the organization shall ever hire employees to perform this contract or any portion thereof, the organization shall obtain Workers' Compensation Insurance and provide proof of Workers' Compensation Insurance coverage to the City of La Quinta. If the organization shall ever hire a subcontractor to perform this contract or any portion thereof, and the subcontractor has employees, then the organization shall require its subcontractor to obtain Workers' Compensation Insurance Coverage, or the organization shall obtain Workers' Compensation Coverage for that subcontractor's employees. This document constitutes a declaration by the organization against its financial interest, relative to any claims it should assert under the California Workers' Compensation and/or Labor laws against City of La Quinta relating to any bid or contract awarded to John Cuevas The organization will defend, indemnify and hold harmless the City of La Quinta from any and all claims and liability, including Workers' Compensation claims and liability that may be asserted or established by any party in the event the organization hires an employee in violation of this addendum, and the organization will further indemnify the City of La Quinta for all damages the. City of La Quinta thereby suffers. I agree that these declarations shall constitute an addendum to any bid or contracts awarded to John Cuevas 7/17/2018 Date A I Iorized Representa GEfC California Evidence of Liability Insurance 1-800-841-30o0 geiaa.00M GEICO GENERAL INSURANCE COMPANY PO BOX 509090 SAN DIEGO, CA 92150-9090 NAIC Code; 35882 Policy Number Effective Date :: Expiration Date 4517779759 11-09=18: 05-09 19 Year Make Model '- Vehicle ID No. 2015 HONDA CR-V LX _: 2HKRM3H37FH560038 Insured: JOHN MANUELCUEVAS SANDY GARCIACUEVAS 77535 CALIFORNIA DR PALM DESERT, CA 92211-8012 Evidence of Insurance Here are your Evidence of Liability Insurance Cards. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1 ,000 for the first time $2,000 for additional times Also, ajudge can have your vehicle impounded - False proof of insurance may result in a fine up to $750 and 30 days in prison. The cove,a,s provided tv this policy meals the minimum requirements o, secllons 16056 a 16500 5 o, 11-te California Due to space limitations on the I D card, only the Vehicle code, minimum liability limits prescribed by law Named Insured and the Co-insured are listed. For a full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page,which is included with your insurance packet. If you would like additional ID cards you can go online to geico.com or call us at 1-800-841-3000. What to do at the time of an accident. • Do not admit fault. • Do not reveal the limits of your liability coverage to anyone. • Exchange contact information; get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1-800-841-3000 or visit geico.com to report the accident. U-4-CA (11-09) GE'CO Tel: 1-800-841-3000 gerlco.com GEICO GENERAL INSURANCE COMPANY P.O. Box 509090 San Diego, CA 92150-9090 Date Issued: October 6, 2018 JOHN M CUEVAS AND SANDY E GARCIACUEVAS 77535 CALIFORNIA DR PALM DESERT CA 92211-8012 Email Address: cuevex@gmail.com Declarations Page This is a description of your coverage. Please retain for your records. Policy Number: 4517-77-97-59 Coverage Period: 11-09-18 through 05-09-19 12:01 a.m standard time at the address of the named insured Named Insured Additional Drivers John M Cuevas None Sandy E Garciacuevas Vehicles VIN Vehicle Location Finance Comlaanv/ Lienholder 1 2015 Honda CR-V LX 2HKRM3H37FH560038 Palm Desert CA 92211 Kinecta Federal Credit Un 2 2003 Honda Civic LX 2HGES16563H541340 Palm Desert CA 92211 Coverages' Limits and/or Deductibles Vehicle 1 Vehicle 2 Bodily Injury Liability Each Person/Each Occurrence $20,000/$40,000 $49.90 $38.60 State Minimum $15,000/$30,0000 ------------------------------ -- - ... -----•-•---------- Property Damage Liability $25,000 $63.20 .., $53.40 State Minimum $5,000 ...... ........... ........... .------------- ..................................... • Medical Payments _._._._._._._._.......... . ...••-------•---•-•-• ---------- • $5,000 . . .. ..... . ..... ....... $17.60 $12.60 Uninsured & Underinsured Motorists Each Person/Each Occurrence $15,000/$30,000 $13.40 $9.70 Uninsured Motorists Property Damage ------------- $3,500 - $2.40 Comprehensive ---------------- ........ $500 Ded ....-•---......----•-------------- $17.40 ................. ................ - . Collision $500 Ded $107.10 Six Month Premium Per Vehicle $268.60 $116.70 Total Six Month Premium $385.30 *Coverage applies where a premium or $0.00 is shown for a vehicle. If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount will be shown on your billing statements and is subject to change. DEC —PAGE (03-14) (Pagel of 4) Continued on Back Renewal Policy Page 7 of 50 EXHIBIT F INDEMNIFICATION F.1 General Indemnification Provision. a. Indemnification for Professional Liability. When the law establishes a professional standard of care for Artist's services, to the fullest extent permitted by law, Artist shall indemnify, protect, defend (with counsel selected by City), and hold harmless City and any and all of its officials, employees, and agents ("Indemnified Parties") from and against any and all claims, losses, liabilities of every kind, nature, and description, damages, injury (including, without limitation, injury to or death of an employee of Artist or of any subcontractor), costs and expenses of any kind, whether actual, alleged or threatened, including, without limitation, incidental and consequential damages, court costs, attorneys' fees, litigation expenses, and fees of expert consultants or expert witnesses incurred in connection therewith and costs of investigation, to the extent same are cause in whole or in part by any negligent or wrongful act, error or omission of Artist, its officers, agents, employees or subcontractors (or any entity or individual that Artist shall bear the legal liability thereof) in the performance of professional services under this agreement. With respect to the design of public improvements, the Artist shall not be liable for any injuries or property damage resulting from the reuse of the design at a location other than that specified in Exhibit A without the written consent of the Artist. b. Indemnification for Other Than Professional Liability. Other than in the performance of professional services and to the full extent permitted by law, Artist shall indemnify, defend (with counsel selected by City), and hold harmless the Indemnified Parties from and against any liability (including liability for claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses or costs of any kind, whether actual, alleged or threatened, including, without limitation, incidental and consequential damages, court costs, attorneys' fees, litigation expenses, and fees of expert consultants or expert witnesses) incurred in connection therewith and costs of investigation, where the same arise out of, are a consequence of, or are in any way attributable to, in whole or in part, the performance of this Agreement by Artist or by any individual or entity for which Artist is legally liable, including but not limited to officers, agents, employees, or subcontractors of Artist. F.2 Standard Indemnification Provisions. Artist agrees to obtain executed indemnity agreements with provisions identical to those set forth herein this section from each and every subcontractor or any other person or entity involved by, for, with or on behalf of Artist in the performance of this Agreement. In the event Artist fails to obtain such indemnity obligations from others as required herein, Artist agrees to be fully responsible according to the terms of this Exhibit. Failure of City to monitor compliance with these requirements imposes no additional obligations on City and will in no way act as a waiver of any rights hereunder. This obligation to indemnify and defend City as set forth herein is binding on the successors, assigns or heirs of Artist and shall survive the termination of this agreement or this section. a. Limitation of Indem. Without affecting the rights of City under any provision of this agreement, Artist shall not be required to indemnify'and hold harmless City for liability attributable to the active negligence of City, provided such active negligence is determined by agreement between the Last Revised April 2015 Page 24 of 25 parties or by the findings of a court of competent jurisdiction. In instances where City is shown to have been actively negligent and where City's active negligence accounts for only a percentage of the liability involved, the obligation of Artist will be for that entire portion or percentage of liability not attributable to the active negligence of City. Last Revised April 2015 Page 25 of 25