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Insurance Certificates 2019 Cuevas, JohnAC DATE IMMIDDlYYYYI CERTIFICATE OF LIABILITY INSURANCE 0212512019 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 he 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 NAMe ACT Program Support Veracity Insurance Solutions, LLC. flue N ,r. �844j§20-6991 i�c,Nol. (801)-7831374 260 South 2500 West, Suite 303 E-MAIL ADORESB info actinsurance.00m Pleasant Grove UT 84062 _..___._.. _...___. ___ i ...._. INSURER A INSURED INS URER B Jahn Cuevas INSURER C: 77535 California Drive INSURER D Palm Desert CA 92211 INSURER E; 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 TYPE OF INSURANCE ADDL 5UHR POLICY EFF POLICY E X P LIMITS LTR POLICY NUMBER MhVDDIYYYY MMIODIYYYY GENERAL LIABILITY EACH OCCURRENCE S 1.000,000 X 300'000 COMMERCIAL GENERAL LIABILITY x PREMISES jFa occurrence S CLAIMS -MADE X OCCUR MEO E)[P (Any one person) $ 5,0150 A PL1744466-AA09072OX 08104/2018 0&0412019 PERSONAL & ADV INJURY S 1,000,000 S 2.000,000 _ GENERAL AGGREGATE S 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER, PRODUCTS -COMPIOPAGG K POLICY j Cr LOC ANIMAL &AILEE S AUTOMOBILE LIABILITY r COMBINED SINGLE LIIAIT F S ANY AUTO BODILY INJVRY ICer person) _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aceldwi) S _ NON4 NED WAUTOS PROPERTY DAMAGE S HIRED AUTOS (per acodenq S UMBRELLA LIAR OCCUR F_ F EACHOCCURRENCE S S EXCESS LIAR CLAIMS -MADE AGGREGATE _ $ DED RETENTIONS WORKERS COMPENSATION WC STA1L- OTH- AND EMPLOYERS' LIABILI7'r YIN _. TORV iM TER ANY PROPRIE'rOR+PARTNEFUEXECUTIVE E.L. EACH ACCIDENT S OFFICElMEMBER EXCLUDED? ❑ NIA {Mandatory in IN HI F. I. DISEASE - EA EMPLOYEE $ If yes. desvlbe under DESCRIPTION OF i�FPFReaIQNS bNow E.L. DISEASE -POLICY LIMIT. S F. F DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {Attach ACORD 101, Additional Remarks Schedule. N more span is requiredl 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 r rIPTIFIr:ATF wni nFR f:ANr izi I ATInM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of La Quinta, its Officers, officials, employees and agents THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ( �% © 1933-2014 ACORD CORPORATION. All rights reserved. ACORD 25 [2014101) The ACORD name and logo are registered marks of ACOR❑ INS025 f2Q14011 GREATAmERIcaN 11430MANre corPAMPES Policy Number: PL1744466-AA09072OX Effective Dale of Change:07/24/2018 BUSINESSPRO POLICY CHANGES NAMED INSURED AND ADDRESS: POLICY PERIOD: John Cuevas 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE 77535 California Drive NAMED INSURED SHOWN AT LEFT. Palm Desert, CA 92211 FROM: 08/04/2018 TO: 08/04/2019 THIS ENDORSEMENT CHANGES BROKER NAME AND ADDRESS: THE POLICY. Veracity Insurance Solutions, LLC. 260 South 2500 West, Suite 303 PLEASE READ IT CAREFULLY. Pleasant Grove, Utah 84062 INSURANCE IS AFFORDED BY THE COMPANY INDICATED BELOW: (EACH A CAPITAL STOCK CORPORATION) GREAT AMERICAN INSURANCE COMPANY ( ) GREAT AMERICAN ASSURANCE CO. (X) GREAT AMERICAN ALLIANCE INS. CO. ( ) GREAT AMERICAN INSURANCE CO. OF NY ( ) GREAT AMERICAN E & S INSURANCE COMPANY It is hereby understood and agreed that the following form has been added to the policy of the above mentioned: ❑ Additional Insured — Vendors CG2015 (Ed. 04 13) with primary and noncontributory wording PI Additional Insured — Designated Person or Organization CG 20 26 (Ed .04/13) with primary and no nco nt ributo ry wo rding ❑ Primary and Noncontributory — Other Insurance Condition CG 20 01 (Ed. 04 13) ❑ Waiver of Transfer of Rights of Recovery Against Others to Us CG 24 04 (Ed. 05 09) ❑ Trailer Endorsement — Amendment tc Exclusion -Aircraft, Auto or Watercraft CG 88 02 (Ed. 11 85) ❑ Increase Inland Marine Limits to $ (maximum payout for any one article) / $ (annual aggregate} ❑ Increase Aggregate Limits to $2M ❑ General Endorsement — Professional Coverage Extension CG 88 02 (Ed.11 85) ❑ Loss Payable Provisions — CM 78 70 (Ed. 06 92) All other terms and conditions remain the same. CG 20 01 (Ed. 04 13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Prirnary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance avail- able to an additional insured under your policy provided that: CG 20 01 (Ed. 04113) (1) the Additional Insured is a Named Insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. Copyright, ISO Properties, Inc., 2012 PL1744466-AA09072OX THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED —DESIGNATED PERSON OR ORGANIiAT ION This endorsement modifies insurance provides under be following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(%) or Organiza#ion(9): Th$ City of La Quints, its pffperS, olfiCials, employees and agents Info rmaton mquired t4 cornple% this Schedule, if not Shown above, valI be 6hown in the Declarations. GG 20 26 (Ed. 04 13) A. SECTION II - WHO IS AN INSURED Is amended to include as an Additional Insured the person(s) ar organizatiorr(sj shown in the Schedule, but only with respect to liability for "bodily injury,' 'property damage' or "personal and advel sing Irqury' Caused, in whole or in part, by your acts or omissions or the acts cr omissions of those acting on your be halt. t_ in Cie performance ofyourongoIN operations; or 2, in connection with your premises uwned by vF rented tie you, However. 1. the insurance afforded to such additional Insured only applles Io the extarApemtilued bylaw: and 2, ilcoverage provided to the Additional Insured is required by a contract oragreement, the insurance afforded to such additlgnoI Insured will riot be broader than that which you are rsgtired by the ConnG1 or agreement to provide for such additional insured. B. With respect to the insurance afforded to these Additional Insureds, the fallowing is added ID SECTION III UMIT$ 4F INSURANCE: If Coverage provided to the Additional Irtsured 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 contracl or agreement or 2, available under the applicable Limits of Insurence shown in the Deciaraflons: whrehe Ma r is Is s s. This end orsemerrtshall not increase She applicable Limits of Insurance shown in the Declr}rafi4ns. CG 20 26 {Ed. D413) PRO G E' C C . Tel: 1-800-841-3000 g@ICO.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 Named Insured John M Cuevas Sandy E Garciacuevas Vehicles VIN 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. Additional Drivers None Vehicle Location 1 2015 Honda CR-V LX 2HKRM3H37FH560038 Palm Desert CA 92211 2 2003 Honda Civic LX 2HGES16563H541340 Palm Desert CA 92211 Coverages* Bodily Injury Liability Each Person/Each Occurrence State Minimum $15,000/$30,0000 Property Damage Liability State Minimum $5,000 Medical Payments Uninsured & Underinsured Motorists Each Person/Each Occurrence Uninsured Motorists Property Damage ................................................................................ Comprehensive Collision Finance Company/ Lienholder Kinecta Federal Credit Un Limits and/or Deductibles Vehicle 1 Vehicle 2 $20,000/$40,000 $49.90 $38.60 ---------------------------------------------------------------------------------------------------------------------- ---------------- $25,000 $63.20 $53.40 $5,000 $17.60 $12.60 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) (Page 1 of 4) Continued on Back Renewal Policy Page 7 of 50 Discounts Multi -Car (All Vehicles) Subclass Factor (All Vehicles) Anti -Theft Device (Veh 1) California Good Driver (All Vehicles) California Persistency (All Vehicles) Passive Restraint/Air Bag (All Vehicles) Group Insurance Plan: Professional Group Insurance Plan Contract Type: A30CA Contract Amendments: ALL VEHICLES - A30CA A54CA Unit Endorsements: A426 (VEH 2); UE316C (VEH 1) Class: A -N -19MM Q (VEH 1); A -L -19MF A (VEH 2) Important Policy Information -The estimated annual mileage figures applicable to the vehicles on your policy for the current and upcoming policy periods are: Vehicle Current Mileage Upcoming Mileage 2015 HONDA CR-V LX 9,000 9,000 2003 HONDA CIVIC LX 1,850 1,850 -Please verify that the coverages you requested are accurately reflected on your Declarations Page. Visit geico.com to review additional coverages and/or limits available to you. -No coverage is provided in Mexico. -Reminder - Physical damage coverage will not cover loss for custom options on an owned automobile, including equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported to us. This reminder does NOT apply in VIRGINIA, however, in Virginia coverage is limited for custom furnishings or equipment on pick-up trucks and vans but you may purchase coverage for this equipment. Please call us at 1-800-841-3000 or visit us at geico.com if you have any questions. -You have elected to receive your insurance documents via electronic delivery at the following electronic mail address: cuevex@gmail.com. To change the address where you receive your policy documents, visit geico.com, or call 1-800-841-3000. -Congratulations! Your policy qualifies for the Professional Group Insurance Plan and includes a savings of $90.10. -Claims incurred while an insured vehicle is being used to carry passengers for hire may not be covered by this contract. Please review the contract for a full list of exclusions and contact us if you plan to use any of your insured vehicles for this purpose. -In California, you have the right to designate one person to receive notices from GEICO if your policy is about to cancel or expire for non-payment. Your designee will not have any rights or benefits under your policy other than the right to receive the notice or make a payment. You can change or remove the designee at any time. If you would like to add, change or remove a designee from your policy, simply log into your account at geico.com or call us at 1-800-841-3000. Continued on Next Page DEC_PAGE (03-14) (Page 2 of 4) Renewal Policy Page 8 of 50 Important Policy Information -In accordance with Section 1872.87 of the California Insurance Code, in addition to your premium, a $0.88 charge per vehicle is assessed to fund auto insurance fraud reduction initiatives. This charge is applied once per policy term per vehicle. -Confirmation of coverage has been sent to your lienholder and/or additional insured. DEC_PAGE (03-14) (Page 3 of 4) Renewal Policy Page 9 of 50 DEC_PAGE (03-14) (Page 4 of 4) Renewal Policy Page 10 of 50 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 Iaws 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 2/25/2019 Date Au orixed Representa