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Insurance Certificates 2019/20 Family Hospice Care (Volunteer) - Bereavement GroupCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/6/2019 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(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 endorsementfsl. PRODUCER Arthur J Gallagher & Co. Insurance Brokers of CA., Inc. 7777 Center Avenue #400 Huntington Beach CA 92647 INSURED Family Hospice Care LLC Prime Healthcare Inc. 8510 Balboa Avenue #285 Northridge CA 91325 FAM 714- COVERAGE :v Co of America COVERAGES CERTIFICATE NUMBER:1898414938 REVISION NUMBER: NAIC # 25674 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 IADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MMIDDIYYYY MMI DNYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY 6301F993178TIL19 12/6/2019 12/8/2020 EACH OCCURRENCE $1.000,000 PREMISES F�occurrence $ 100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 1-1 �JE El LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHEM AUTOMOBILE LIABILITY COMBiNEp INGLELIMIT E8 acx�dent $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS Peraccident) BODILY INJURY ( $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE per aCddenl $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ NIA 7ATllTE E E.L.EACHACCIDENT $ E-L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L- DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 7 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of La Quinta, its elected and appointed officials, officers, employees, and volunteers (for purposes of this policy, Individual afid collectively, the "City Insureds") are included as additional insureds as respects to the General Liability Coverage for the event dates June 2019 to June 2020. All coverage is per the policy terms and conditions. Policy exclusions, limitations and endorsements may apply to the stated coverage. CERTIFICATE HOLDER CANCELLATION The City of La Quinta Wellness Center 78-495 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 630IF993178TIL19 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 12_06_2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): The City of La Quinta, its elected and appointed officials, officers, employees and volunteers (for the purposes of this policy, individual and collectively, the "City Insureds") PROJECT/LOCATION OF COVERED OPERATIONS: 78-495 Calle Tampico La Quinta, CA 92253 1. WHO IS AN INSURED — (Section ll) is amended b) The insurance provided to the additional in- to include the person or organization shown in the sured does not apply to 'bodily injury", "prop - Schedule above, but: erty damage" or "personal injury" arising out a) Only with respect to liability for "bodily injury", of the rendering of, or failure to render, any "property damage" or "personal injury"; and professional architectural, engineering or sur- veying services, including: b) If, and only to the extent that, the injury or I. The preparing, approving, or failing to damage is caused by acts or omissions of you or your subcontractor in the performance prepare or approve, maps, shop draw - of "your work" on or for the project, or at the ings, opinions, reports, surveys, field or - location, shown in the Schedule. The person ders or change orders, or the preparing, or organization does not qualify as an addi- approving, or failing to prepare or ap- tional insured with respect to the independent prove, drawings and specifications; and acts or omissions of such person or organiza- ii. Supervisory, inspection, architectural or tion. engineering activities. 2. The insurance provided to the additional insured c) The insurance provided to the additional in - by this endorsement is limited as follows: sured does not apply to "bodily injury" or a) In the event that the Limits of Insurance of "property damage" caused by "your work" this Coverage Part shown in the Declarations and included in the "products -completed op - exceed the limits of liability required by a erations hazard" unless a "written contract "written contract requiring insurance" for that requiring insurance" specifically requires you additional insured, the insurance provided to to provide such coverage for that additional the additional insured shall be limited to the insured, and then the insurance provided to limits of liability required by that "written con- the additional insured applies only to such "property tract requiring insurance". This endorsement 'bodily injury" or damage" that oc- shall not increase the limits of insurance de- curs before the end of the period of time for scribed in Section III — Limits Of Insurance. which the "written contract requiring insur- ance" requires you to provide such coverage CG D2 47 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance', whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "written contract requiring insurance" for that ad- ditional insured specifically requires that this in- surance apply on a primary basis or a primary and non-contributory basis, this insurance is pri- mary to 'other insurance' available to the addi- tional insured which covers that person or organi- zation as a named insured for such loss, and we will not share with that 'other insurance'. But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other insurance', whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional in- sured under such 'other insurance'. 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an 'occur- rence' or an offense which may result in a claim. To the extent possible, such notice should include: I. How, when and where the 'occurrence' or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence' or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of 'other insurance' which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance' available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage' oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 47 08 05