Vielhaber, Karen Insurance DocsINSURANCE REVIEW
RE:
Please list the Contracting Party / Vendor Name, type of agreement to be executed, including any change orders or
amendments, and the type of services to be provided. Make sure to list any related Project No. and Project Name.
Insurance certificates required per the Agreement:
ACCORD Certificate dated 10-days prior or less _____________________________
enter ACCORD issue date
Commercial General Liability Insurance:
$1,000,000 per occurrence/$2,000,000 aggregate OR
$2,000,000 per occurrence/$4,000,000 aggregate
Additional Insured Endorsement naming City of La Quinta
Primary and Non-Contributory Endorsement
Automobile Liability:
$1,000,000 combined single limit for bodily injury and property damage.
Workers’ Compensation:
Statutory Limits / Employer’s Liability $1,000,000 per accident or disease
Workers’ Compensation Endorsement with Waiver of Subrogation
Sole Proprietor
Professional Liability (Errors and Omissions):
Errors and Omissions Liability insurance with a limit of not less than
$1,000,000 per claim
Cyber Liability/Technology Errors and Omissions Liability Insurance:
$1,000,000 per occurrence/loss
Other: ________________________________________________________
List other insurance types such as – molestation, harassment, etc.
Approved by: ________________________
Date: ________________________
Karen Vielhaber, Instructor Agreement for Instructing Yoga/Fitness Classes at
the Wellness Center.
September 28, 2021
✔
✔
✔
✔
Monika Radeva
10/1/2021
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PI-GL-005 (07/12)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
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):
Effective Date:
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.
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