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Insurance Certificates 2021/22 Urban Habitat - SRR Park Venue Project 2016-08�-� URBAHAS-01 ACO/zL7 CERTIFICATE OF LIABILITY INSURANCE VIRAINTER DATE (MMIDD/YYYY)6/23/2021 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 BYTHE 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 endorsements). PRODUCER License # OC32169 Rancho Mesa Insurance Services, Inc. 250 Riverview Parkway Santee, CA 92071 k0TACT aco,N o, 619 937-0164 Alec, No :(619) 937-0168 M I E: INSURER 8 AFFORDING COVERAGE NAIC! INSURER A: Middlesex Insurance Com a ny 23434 INSURED Urban Habitat P.O. Box 1177 La Quinta, CA 92247 INSURER B :Oak River Insurance Company 34630 INSURERC: INSURER D : INSURER E INSURER F : /�G�TrBAaTG �n we Gn. a QFVI_Qlnkl h111MRFR- 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 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. INSR LTR TYPE OF INSURANCE ADDL INAD SUBR POLICY NUMBER POLICY EFF POLICY EXP IIMR'S A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X X 0116293004 7/1/2021 7/1/2022 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED 500,000 MED EXP oneperson) 5,000 PERSONAL & ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑X jE T LOC OTHER: GENERAL AGGREGATE 3,000,000 PRODUCTS- COMPIOP AGG 2,000,000 A AuroMOBILELIaaIurY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS p X AUTOS ONLY X AUTOS OY A0116293001 711/2021 7/1/2022 COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY(Per Personi BODILY INJURY (Per accident PRerOac�dden DAMAGE A X UMBRELLALIAB EXCESSuas X I OCCUR I CLAIMS -MADE A0116293005 71l/2021 7/1/2022 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PRO RIETORMEMBER PPARTUOED?ECU� OFF(Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA X URWC205459 7/1/2021 7/1/2022 X I ST&TEFORTH E.L. EACH ACCIDENT 11000,000 E.L. DISEASE- EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 T1 I -L - � DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more apace is required) RE: JOB #2016-08 - LA QUINTA SILVERROCK PARK VENUE, 79179 AHMANSON LANE, LA QUINTA, CA 92293. CITY OF LA QUINTA AND ITS OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED PER FORM CG2010 AND CG2037 ATTACHED. PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES. (p) CITY OF LA QUINTA 78496 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 ACORD 25 (2016/03) 91986-ZU15 AGUKU cUKIVKAI lulu. Air rlgnis reserveu. 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 in effect prior to any accident, injury, loss or damage Description: Jobsites as described in contracts 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: 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. CG20100413 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. O Insurance Services Office, Inc., 2012 bf9W9b-b73#d9ca5ef-2561 d9464W Page 1 of 2 06/23/2021 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 2010 0413 A0116293 06/23/2021 Middlesex Insurance Company POLICY NUMBER: A0116293004 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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: 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 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-a&ff 4be3a120-19se0W06W Page 1 of 1 06/23/2021 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 O Insurance Services Office, Inc., 2008 cf0208de-3038-488G,%Sb-4dbed2201d5fl Page 1 of 1 06/23/2021 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 (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. 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 © Insurance Services Office, Inc., 2012 542efta6903e 4180-b5&-4a36818e8301 Page 1 of 1 06/23/2021 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed. 01-19) 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 calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 2611.00 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: 07/01/2021 PolicyNo.: URWC205459 Endorsement No.: Insured: Urban Habitat Premium $ Insurance Company: Oak River Insurance Company Countersigned by WC 99 0410 C (Ed. 01-19)