Insurance Certificates 2022/23 Charles Sullivan (Volunteer Coordinator) - Ukulele PracticeINSURANCE 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: ________________________
Chuck Sullivan, Volunteer Coordinator (FY 2022) for Desert Oasis Strummers Group.
xx
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 20223101
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with
Apex Insurance Services
P. O. Box 6450
Newport Beach, CA 92658
License No: OC 36861
CITY OF LA QUINTA
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
NAMED INSURED (EVENT HOLDER):
CHUCK SULLIVAN
48610 VISTA ESTRELLA
LA QUINTA, CA 92253
EVENT INFORMATION:
TYPE: UKULELE STRUMMERS GROUP
DATE(S): 1/01/2022 – 12/31/2022
LOCATION: LA QUINTA WELLNESS CENTER
*Liquor Liability Yes No x
**Liquor Liability after 12 am ends before 2 am
This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy
period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless
amended as described in Special Conditions.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER MKLV7PBC000569
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2022, EXPIRATION: JANUARY 1, 2023
COMMERCIAL GENERAL LIABILITY
General Aggregate Limit
Products & Completed Operations
Personal & Advertising Injury
Each Occurrence Limit
Damage To Premises Rented To You (Any One Premises)
Medical Payments (Any One Person)
Liquor Liability (If purchased)
Optional Limits Purchased
$1,000,000/$3,000,000
$2,000,000/$2,000,000
Damage To Property (If purchased)
$ 2,000,000
1,000,000
1,000,000
1,000,000
100,000
5,000
1,000,000
OCCURRENCE FORM
DEDUCTIBLE: NONE
SPECIAL CONDITIONS:
The following endorsements attached to
the Master Policy do not apply to this
Certificate Of Insurance:
MEGL643
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been i ssued for that event.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy
provisions.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: 1-31-2022
From:Caroline Doran
To:Nadia Fuentes
Cc:Nichole Romane
Subject:Insurance Chuck Sullivan
Date:Thursday, February 10, 2022 5:56:04 PM
Attachments:Insurance Review Approval Chuck Sullivan.pdf
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Hello Nichole,
Insurance approval attached for Chuck Sullivan Ukulele Strummers Group 1-1-2022
until 12-31-2022.
This is the note about additional insurance and primary non contributory from JPIA Alex
Mellor.
Since you are using our Special Events Program (which is really Alliant’s Special Events Program), you don’t
need to worry about the endorsements and other items you mention below. This is one of the major benefits
of the program – the city is automatically additional insured, coverage applies on a primary/non-contributory
basis etc.
Thank you,
Caroline Doran | Community Resources Specialist
Community Resources
City of La Quinta
78495 Calle Tampico ◦ La Quinta, CA 92253
Ph. 760.777.7182
www.laquintaca.gov
www.playinlaquinta.com