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Insurance Certificates 2018/19 ClearSource FinancialCLEAR-1 OP ID: CG DATE 03/04/2019 ) 03/04/2019 CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . PRODUCER 831-337-4661 Clarion Pacific Insurance 2035 N.. Pacific Ave. NAME CT Goryn Gardiner PHONE 831-337-4661 FAx 831-612-1810 (A/C, No, Ext): (AIC, No): A pRLE : Coryn@pac-risk.com Santa Cruz, CA 95060 Ryan Deane INSURERS AFFORDING COVERAGE NAIC # INSURERA:Philadelphia Indemnity 18058 INSURED Consul inq Financial Consultin Terry Madsen 7960 Soctuel Dr. ste: B363 Aptos, CA 95003 INSURER B : Travelers Property Casualty Co 25674 INSURER C Nationwide Mutual Insurance Co 23787 INSURER D INSURER E INSURER F : Ct7VFRAnFR CERTIFICATE An IMRFR- RFVI_CIr1M MI IMRFR- 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 LTRC TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X ACP 3009102473 12/09/2018 12/09/2019 EACH OCCURRENCE $ 1,000,000 DAMAGMISE TO RENTED $ 50,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY COMBINED "OentjSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ ANY AUTO ACP 3009102473 12/09/2018 12/09/2019 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS X PROPERTY DAMAGE Per accident $ HIRED Ix NON -AWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ _ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) N / A X UB-8M759710-19-42 01/01/2019 01/01/2020 X PTR OTH- E.L. EACH ACCIDENT - 1000,000 $ ' E.L. DISEASE - EA EMPLOYEE _ $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 A Professional Liab PHSD1302245 12/09/2018 12/09/2019 Occurence 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City, its officers, officers, employees, agents and volunteers are named additional insured per form PB 04 48 11 14 with respect to the operations of named insured. 30 Day notice of cancellation will be provided to certificate holder for cancellation or reduction in coverage. 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB 04 48 11 14 ongouv#111"m ADDITIONAL INSURED — DESIG. i PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following is added to Section II. WHO IS AN INSURED: Any person or organization shown in the Schedule of this endorsement is also an insured, 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 in the performance of your ongoing operations or 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 contract or agreement, the insurance afforded to such additional insured will not be broaderthan 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 Ill. LIMITS OF INSURANCE AND DEDUCTIBLE: 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. C. This insurance, including any duty we have to defend "suits", does not apply to: 1. "Bodily injury" or "property damage" that arises out of, in whole or in part, or is a result of, in whole or in part, the active negligence of the additional insured shown in the Schedule of this endorsement. 2. "Personal and advertising injury" that arises out of any independent "personal and advertising injury" offense committed by the additional insured shown in the Schedule of this endorsement. All terms and conditions of this policy apply unless modified by this endorsement. I4:141.141114 Name Of Person Or Organization: THE CITY OF LA QUINTA, ITS OFFICERS, EMPLOYEES SEE BLANK ENDORSEMENT PB2500 PB 04 4811 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 ACP BPO 3009102473 INSURED COPY 47 04085 EFFECTIVE DATE: 12:01 AM Standard Time, (at your principal place of business) BUSINESSOWNERS PB 25 00 (01-01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OFM001 COMPLETE NAMES & ADDRESSES OF THE ADDITIONAL INSURED RE: PBO448 THE CITY OF LA QUINTA, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS RESPECTS: LIABILITY ARISING OUT OF ACTIVITIES PERFORMED BY OR ON BEHALF OF CONSULTANT; PRODUCTS AND COMPLETED OPERATIONS OF CONSULTANT; PREMISES OWNED, OCCUPIED OR USED BY CONSULTANT; AUTOMOBILES OWNED, LEASED, HIRED OR BORROWED BY CONSULTANT. 78495 CALLE TAMPICO LA QUINTA, CA 92253 All terms and conditions of this policy apply unless modified by this endorsement. PB 25 00 (01-01) ACP BPO 3009102473 INSURED COPY 47 04086 BUSINESSOWNERS PB 60 72 07 11 This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS Only with respect to any additional insured, in the COMMON POLICY CONDITIONS, form PB 00 09, under condition H. OTHER INSURANCE, paragraph 2.a. is replaced by the following: H. OTHER INSURANCE 2. Under any liability coverage provided by this policy, a. If for injury or loss we cover, there is other valid and collectible insurance available to any additional insured under another policy, our obligations are limited as follows: (1) Issued by another insurer, or if there is self insurance or similar risk retention that applies to a loss covered by this policy, then this insurance provided by us shall be excess over such other insurance, unless you have agreed in a written contract or written agreement signed prior to the loss that this insurance shall be primary: (a) Then this insurance is primary. If other insurance is also primary, we will share with all that other insurance as described in d. below; and (b) The coverage afforded by this insurance is non-contributory with the additional insured's own insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured to any other person or organization's policy.; or (2) Issued by us or any of our affiliate companies, that applies to a loss covered by this policy, then only the highest applicable Limit of Insurance shall apply to such loss: This condition does not apply to any policy issued by us that is designed to provide Excess or Umbrella liability insurance. All terms and conditions of this policy apply unless modified by this endorsement. PB 60 72 07 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ACP BPO 3009102473 INSURED COPY 47 04087 0�' V�Q������DK0��NSATON Aw TRAVELERS o�m���Q�~�� ^ AND ONE TOWER SQ UARE HARTroao cr 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT VV[M4O3QG(O1) — oue POLICY NUMBER: UB-BM759710-19-42-G We have the right to recover our payments from anyone liable for aninjury 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. PERSON OR ORGANIZATION czTr OF LA OnzmzA vo-«ss ouLLE zxmoezco P.O. BOX 1504 LA SCHEDULE FIRE RELATED FEES COST mrSERVICES STUDY FOR DATE OF ISSUE: 10-30-18 ST ASSIGN: Page 1 of i