2020/21 Earthquake Insurance Policy - Declaration PageFS C 422 01 13 20-Feb-2020 12:21:57 PM Page 1 of 2
COMMERCIAL PROPERTY
FS C 422 01 13
GENERAL COVER DECLARATIONS PAGE
THE COVERHOLDER THE PRODUCER
Beazley Insurance Services
CA license #: 0G55497
101 California Street, Suite 1850
San Francisco, CA 94111
AmWINS Insurance Brokerage of California - Irvine,
CA
2010 Main Street
Ste 700
Irvine, CA 92614
Please send correspondence to the above address.
Beazley Lloyd’s Syndicate 2623-82%
Beazley Lloyd’s Syndicate 623-18%
Unique Market Reference: B6012BUSA20
POLICY NUMBER: W14D19200701 POLICY PERIOD
Renewal of W14D19190601 From:07-Feb-2020
To:07-Feb-2021
at 12:01 A.M. Standard Time at the Insured's
Address
INSURED'S NAME AND ADDRESS
City of La Quinta
78-495 Calle Tampico
La Qunita, CA 92253
PERILS INSURED AGAINST:
Earthquake
PREMIUM:
$170,000 Policy Premium
Declined Certified Acts of Terrorism Premium
$0 Inspection Fees
$170,000.00 Total Premium for above stated Policy Period
CLAIMS:
In case of loss, please refer notice immediately to:
Claims Manager
Beazley USA Services Inc.
141 Tremont Street, Suite 1200
Boston, MA 02111
Telephone: 617-239-2600
Fax: 617-239-2659
Email: propertyclaims@beazley.com
California Premium:
NonTaxable Fees:
Taxable Fees:
Surplus Lines Tax:
Stamping Fee:
$170,000.00
$ 5,100.00
$ 425.00
FS C 422 01 13 20-Feb-2020 12:21:57 PM Page 2 of 2
Terms and Conditions Applicable: See FS C 426 12 12 Supplemental Dec Page and /or FS C 424 Schedule of
Forms as attached.
This contract is subject to US state surplus lines requirements. It is the responsibility of the surplus lines broker to
affix a surplus lines notice to the contract document before it is provided to the insured. In the event that the
surplus lines notice is not affixed to the contract document the insured should contact the surplus lines broker.
This Declaration, together with Policy jacket, the above policy wording and endorsements, issued to form a part
thereof, completes the above numbered policy.
Signed:Date Issued:20-Feb-2020
FS C 426 12 12 20-Feb-2020 12:21:57 PM Page 1 of 2
COMMERCIAL PROPERTY
FS C 426 12 12
SUPPLEMENTAL DECLARATIONS PAGE
POLICY NO. W14D19200701 EFFECTIVE DATE 07-Feb-2020
NAMED INSURED
City of La Quinta
78-495 Calle Tampico
La Qunita, CA 92253
£ See 'Additional Named Insured Schedule' attached to this policy.
LOCATION ADDRESS OF LOCATION
Loc.Bldg.
T As per Schedule on file with the Underwriter
Total Insured Value: $69,653,939
COVERAGE LIMIT OF LIABILITY
Real Property
Personal Property
Valuable Papers
Electronic Data Processing Media
Business Income
Extra Expense
Rental Income
Ordinance or Law - Undamaged
Portion (Cov A)
$10,000,000 Each Occurrence and in the Annual Aggregate in respect of
Earthquake
COVERAGE SUB-LIMIT
Ordinance or Law - Demolition (Cov
B) and Increased Cost of
Construction (Cov C) combined
$2,500,000 Sub-Limit
Total LIMIT OF LIABILITY in any one occurrence for all above coverages combined: $10,000,000
DEDUCTIBLE
10.00 % Values Per Unit of
Insurance
$25,000 Minimum Per Occurrence
Earthquake
POLICY FORM CHANGES
FS C 494: Optional Valuation, Section 9. is amended to show Replacement Cost applies to Real Property and
Personal Property.
FS C 494: Limits of Insurance , Section 7. Item B. is deleted in it's entirety.
FS C 426 12 12 20-Feb-2020 12:21:57 PM Page 2 of 2
MORTGAGE HOLDER / LOSS PAYEE
Prem. No.Bldg. No.Mortgage Holder / Loss Payee Name and Mailing
Address
Interest
Mortgage Holder = MH
Loss Payee = LP
N/A
£ As per Schedule on file with the Underwriter
PREMIUM:
$170,000 Policy Premium
Declined Certified Acts of Terrorism Premium
$0 Inspection Fees
$170,000.00 Total Premium for above stated Policy Period