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2020/21 Williams, Billee (Instructor) - Insurance CertificatesDATE (MM/DD/) A� a� CERTIFICATE OF LIABILITY INSURANCE 02/28/2020 PRODUCER Maguire Insurance Agency, Inc, FWI 1 Bala Plz Ste 100 Bala Cynwyd, PA 19004--1401 610617-7900 INSURED Billee Williams 13110 Avenida Rubio La Quinta, CA 92253- COVERAGES THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURER A: Philadelphia Indemnitv Insurance Comoanv 18059 INSURER B: INSURER C: INSURER D: INSURER E: 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/DD/YYYY) POLICY EXPIRATION DATE IMM/DD/YYYY) LIMITS A X GENERAL LIABILITY % COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR X PROFESSIONAL LIABILITY GENT AGGREGATE LIMIT APPLIES PER: % POLICY PROJECT F LOC PHPK2102578- 000 02/28/2020 02/28/2021 EACH OCCURENCE $2,000,000 DAMAGE TO ftn= PREMISES Ean rren ca S100,000 VIED EXP (Anyone person) $2,5D0 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE S4,000.000 PRODUCTS—COMP/OP AGG $4,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (EA accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANYAUTO AUTO ON LY — EA ACCI DENT OTHERTHAN EA ACC AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION EACH OCCURENCE AGGREGATE EMPLOYERS'LIABIUTY Y N ANY PROPRIE UR1PARTNERIEXECUTIVE OF FICERIME M BER EXCLUDE D7 (Mandatory in NH) If Yye�ss descrlhe under S PEC(AL PROVISION5 below TORYUMITS ER E.L. EACH ACCIDENT E-L- DISEASE — EA AMPLOYEE E.L. DISEASE — POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole negligence, CERTIFICATE HOLDER CANCELLATION La Quinta Wellness Center 79450 Avenida La Fonda La Quinta, CA 92253- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2102578-000 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 La Quinta Wellness Center 78450 Avenida La Fonda La Quinta CA 92253- 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 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 contract or 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY CHANGE DOCUMENT POLICY NO: CHANGE # 1 CHANGE EFFECTIVE: 02/28/2020 P H PK2102578-000 Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. FWI NAMED INSURED: Billee Williams MAILING ADDRESS 53110 Avenida Rubio La Quinta, CA 92253- POLICY PERIOD. FROM 02/28/2020 TO 02/28/2021 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected, the policy is amended as indicated below: Amend COI to include CG2026 and PNC Endorsement for: La Quinta Wellness Center 78450 Avenida La Fonda La Quinta CA 92253 Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 Page 1 of 1 PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following. - COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): La Quinta Wellness Center Effective Date: 02/28/2020 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). ACORD 25 (2009/01)