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2018-19 Miller, Tobruk (Instructor) - Fitness Classes1-9-2019 PN 1-9-2019 PN CERTIFICATE OF LIABILITY INSURANCE DA'IF`MMMD"""' 03/14/2019 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(iss) 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: Sports Venbrook Insurance Services, CA Lic OD80832 PHONE Q. E ' AIC Ho 6320 Canoga Ave., 121h Floor ApDREss: INSURERfSI AFFORDING COVERAGE NAIC it Woodland Hills CA 91367 INSURERA : Philadelphia Indemnity Insurance Company INSURED INSURERS! Tobruk Miller INSURER C : 87 Railroad Place INSURER D : INSURERE: Saratoga Springs NY 12866 INSURER F : COVERAGES CERTIFICATE NIIIII GL1931456957 pGVICIAIJ 16111FARIP12. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVr BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 ,11�D POLICY NUMBER M A� M ORDrW YYYYi LIMITS COMMERCIALGENERALLIABILITY CLAIMS -MADE Fx_] OCCUR EACH OCCURRENCE $ 1,000,000 PRE1A ES Aoc onrenr2 $ 100,000 MED EXP (An one person) $ 2,500 Professional Liability PERSONAL BADVINJURY $ 1,000.000 A VB1M3M693532 04/07/2019 04/07/2020 GNSMAGGREGATE LIMITAPPLIES PER: PRO - POLICY ❑ ECTT LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOPAGG $ 3,000,000 Employee Benefits $ OTKR — AUTOMOBILE LIABILITY I p SINGLE Lot r fn arcWerx $ ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY (Pcident erac) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Ll PROPERTY Psr a[a'dsnl $ . $ UMBRELLA LIAB Id OCCUR EACH OCCURRENCE $ EXCE59 LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA pEt� ry_ SF"ER E L EACH ACCIDENT $ E L DISEASE -EAEMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Rernarks Schedule, may be attached N more space is required) *10 Day Notice of Cancellation for Non -Payment of Premium. Certificate Holder is named as Additional Insured as respects General Liability as per policy forms and conditions City of La Quinta 78495 Calle Tampico La Quinta CA 92253 UAN4tLLAI IUN 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 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG20100704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: VB1 M3M693532 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART Nacre Of Additional Insured Person(s) Or Organimtion(s): City of La Quinta 78495 Calle Tampico La Quinta, CA 92553 Insured: Tobruk Miller Policy Term' 4/7/2019 — 4f712020 SCHEDULE Location(s) Of Covered Operations The City of La Quinta, its elected and appointed officials, officers, employees, and volunteers (for purposes of this policy,individual and collectively, the "City Insureds") as additional insureds. I 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 organiza lions) 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 be- half; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above B. With respect to the insurance afforded to these addi tional insureds, the following additional exclusions ap ply' 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 pro jest (other than service, maintenance or repairs) to be performed by or on behalf of the additional in sured(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 con tractor or subcontractor engaged in performing op erations for a principal as a part of the same project CG20100704 © ISO Properties, Inc, 2004 Page 1 of 1 D POLICY NUMBER: V131 M3M693532 Insured: Tobruk Miller Policy Term: 4/7/2019 - 4/7/2020 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of La Quinta 78495 Calle Tampico La Quinta, CA 92553 The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCiAL GENERAL LIABILITY CONDITIONS) is amended by the addition of Iho following: Wo waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damago arising out of your ongoing oparatioM 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. Policy Number: V131M3M693532 Insured: Tobruk Miller Policy Eff. Date: 04/7/2019 — 04/07/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the other insurance condition and supersedes an provision to the contrary (1) The addition 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.