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Insurance Certificates 2019/20 Urban Habitat - SRR Park Venue Project 2016-08URBAHAB-01 WCHIRIBOGA CERTIFICATE OF LIABILITY INSURANCE DAT811912 1 YYY}. r9/2o19►� 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 endorsementisl. PRODUCER Rancho Mesa Insurance Services, Inc. PHONE FAx 250 Riverview Parkway J=. No,�_ 619 937-0164 ta>c, No): (619) 937-0168 Santee, CA 92071 M Fq. INSURED Urban Habitat P.O. Box 1177 La Quinta, CA 92247 A: Middlesex Insurance Company 123434 D: INSURER F : OVERAGES CERTIFICATE NUMBER: 2 REVISION NUMBER: 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. JSR TYPE OF INSURANCE ADM I SUB POLICY NUMBER POLICDY EFF I POLICY EXP LIMITS A ["MERCIAL GENERAL LIABILITY I 1,0000 EACH OCCURRENCE $ , CLAIMS -MADE X OCCUR A0116293004 7/1/2019 7/1/2020 6AMAGE TO RENTED 500 0 X X ¢RFMIS>=R IF. nrr im _1 5 I GENI'LAGGRF_GATE LIMIT APPLIES PER: POLICY FK jEe LOC OTHER: A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOSONLY AUTOS X AUTOSONLY X ARTOS0 A ! UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE DED I A I RETENTIONS B IWORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N/A X IIURWC004126 7I712019 7/1/2020 EACH DISEASEEL. HAC MED EXP (Anv one Derson) I S S I7MBINED SINGLE LIMIT 16293001 71l/2019 7/1/2020 BODILY INJURY IPer ersl i BODILY INJURY (Per accic 7/1/2019 I 7/1/2020 AGGREGATE S 1,000, 1,000,000 below I I I I I F I r11SFACF - Pni Ir:V I IMIT I t 1, DESCRIPTION OF OPERA71ONS I LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more s ace Is required I RE: JOB #2016-08 - LA QUINTA SILVERROCK PARK VENUE, 79179 AHMANSON LANE, LA QUINTA, C 92293 - CIIY OF LA QUINTA AND ITS OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED PERFORM CG2010 AND CG2037 ATTACHED. PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES. (p) CERTIFICATE HOLDER CITY OF LA QUINTA 78495 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0116293004 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization you are required to add as Codes per the General Liability Declaration Page an additional insured under a written contract or Description- Jobsites as described in contracts agreement Description: in effect prior to any accident, injury, loss or damage Jobsites as described in contracts Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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. CG 20 10 0413 A0116293 Middlesex Insurance Company 1 00001 0000000000 19164 0 N B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 0 Insurance Services Office, Inc., 2012 bf9faa9b-b73f-49ac-a5ef-2561 c494646d Page 1 of 2 06/13/2019 C. 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 A01 16293 06/13/2019 Middlesex Insurance Company POLICY NUMBER: A0116293004 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization you are required to add as Jobsites as described in contracts. Codes per the an additional insured under a written contract or General Liability Declaration Page agreement in effect prior to any accident, injury, loss or damage 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. CG 20 37 0413 A0116293 Middlesex Insurance Company 1 00001 0000000000 19164 0 N 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. © Insurance Services Office, Inc., 2012 107b155e-a6df-0e3-a120498e0be306cd Page 1 of 1 06/13/2019 Policy Number: A0116293004 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 A0116293 Middlesex Insurance Company 1 00001 0000000000 19164 0 N (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 542effe6-903e.4180-b56F4a36818e6301 Page 1 of 1 06/13/2019 POLICY NUMBER: A0116293004 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 A0116293 Middlesex Insurance Company 1 00001 0000000000 19164 0 N © Insurance Services Office, Inc., 2008 cf0206de-3038-4680-9a8b-dbed2201d5f7 Page 1 of 1 06/13/2019 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE BLANKET WAIVER Person/Organizatlon Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description All CA Operations Waiver Premium This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2019 Policy No. URWC004126 Endorsement No. Insured Urban Habitat Insurance Company Oak River Insurance Company Countersigned by WC 99 04 10B (Ed. 9-14) Premium $