Insurance Certificates 2021/22 NEI, Inc for Mass GradingDATE (MMIDDIYYYY)
-���►�� CERTIFICATE OF LIABILITY INSURANCE
12/21 /2020
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 endorsement(s).
PRODUCER CONTACT Cynthia Cadenhead
NAME:
Temecula Insurance Services PHONE (951) 694-5200 NC. No): (951) 302-0470
A/C No Ex
41923 Second Street E-MAIL cynthia@temeculainsuranceservices.com
ADDRESS:
Suite 201 INSURER(S) AFFORDING COVERAGE NAIC #
Temecula CA 92590 INSURERA: United Specialty Insurance Company 12537
INSURED INSURER B: Nationwide Mutual Insurance 23787
NEI, Inc. INSURERC: State Compensation Ins. Fund 35076
79811 Country Club Drive Suite B INSURER D :
INSURER E :
Bermuda Dunes CA 92203 INSURER F :
rrnvoonncc CFRTIFIRATF KII IMRFR• CL2052802755 RFVISInN NIIMRFR-
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMIDDY/YYYY
EXP
MMIDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
x_
CLAIMS -MADE /� OCCUR
DAMAGE50,000
PREMISES Ea occurrence
$
MED EXP (Anyoneperson)
$ 5,000
PERSONAL& ADV INJURY
$ 1,000,000
A
Y
ATN2076375
06/01/2020
06/01/2021
GEN'LAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
s 2,000,000
PRODUCTS - COMPIOPAGG
$ 2,000,000
POLICY PRO- JECT LOC
General Aggregate
$ 5,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINEDSINGLE LIMIT
Ea acpdent)
$ 1,000,000
x
BODILY INJURY (Per person)
$
ANY AUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
ACPBA3047725697
06/01/2020
06/01/2021
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Peraccidenl
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
NIA
9266200-2021
01/01/2021
01/01/2022
PER OTH-
X STATUTE ER
E-L EACH ACCIDENT
$ 1,000,000
E.L.DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E-L DISEASE -POLICY LIMIT
$ 1,000,000
Rented/Leased/Borrowed $250,000
Contractors Equipment
B ACPCIM3047725697 06/01/2020 06/01/2021 Deductible $1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Job: SilverRock Resort Mass Grading Phase I. SilverRock Phase I, LLC and/or Silverrock Development Company, LLC, the Robert Green Company (Legal
Entity), Silver Rock Lodging, LLC, SilverRock Luxury Residences, LLC, SilverRock Lifestyle Residences and City of La Quinta are hereby named as
additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS.
78495 Calle Tampico
AUTHORIZED REPRESENTATIVE
La Quinta CA 92253
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD