Insurance Certificates 2022/23 South Coast Air Quality Mgmt District - LQ Evidence of CoverageEVIDENCE OF COVERAGE July 12, 2022 6:16 PM
COVERAGE PROVIDER MEMBER
La Quinta
78-495 Calle Tampico
La Quinta, CA 92253-2839
760-777-7035
California Joint Powers Insurance Authority
8081 Moody Street
La Palma CA 90623
www.cjpia.org
Contact Name: Jim Thyden, Insurance Programs Manager
Phone: (562) 467-8784 Monika Radeva
mradeva@laquintaca.gov
760-777-7035
THIS IS TO CERTIFY THAT THE MEMBER LISTED ABOVE PARTICIPATES IN THE CALIFORNIA JOINT POWERS INSURANCE AUTHORITY’S SELF-
INSURANCE AND COMMERCIAL INSURANCE PROGRAM WITH THE COVERAGES AND LIMITS LISTED BELOW, SUBJECT TO ALL THE TERMS,
DEFINITIONS, EXCLUSIONS, CONDITIONS, AND RESPONSIBILITIES OF THE MEMORANDA OF COVERAGE FOR EACH LINE OF COVERAGE.
COVERAGES
THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE COVERAGE PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EVIDENCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE MEMORANDA DESCRIBED HERIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MEMORANDA. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF COVERAGE MEMORANDUM
COVERAGE
EFFECTIVE DATE
(MM/DD/YY)
LIMITS
LIABILITY AGGREGATE $1,000,000
X OCCURRENCE PRODUCTS-COMP/OP AGG $ N/A
X PERSONAL INJURY PERSONAL & ADV INJURY $1,000,000
X ERROR & OMISSIONS EACH OCCURRENCE $1,000,000
X EMPLOYMENT PRACTICES
M O C L P
7/1/21 – 7/1/23
FIRE DAMAGE (Any one fire)$ N/A
MED EXP (Any one person)$ N/A
AUTOMOBILE LIABILITY
X ANY AUTOS COMBINED SINGLE LIMIT $1,000,000
ALL OWNED AUTOS BODILY INJURY
(Per person)$ N/A
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per accident)$ N/A
NON-OWNED AUTOS
7/1/21 – 7/1/23
PROPERTY DAMAGE $ N/A
WORKER’S COMPENSATION AND
EMPLOYER’S LIABILITY X WC STATUTORY LIMITS $ N/A
M O C W C 7/1/21 – 7/1/23 X EMPLOYER’S LIABILITY $1,000,000
ADDITIONAL REMARKS
CANCELLATION
The California JPIA will endeavor to provide at least thirty (30) days
notice of any cancellation of coverage or reduction in coverage limits to
the Evidence Holder.
EVIDENCE HOLDER
South Coast Air Quality Management District
21865 Copley Drive
Diamond Bar, CA 91765-4178
Cynthia Ravenstein
cravenstein@aqmd.gov
AUTHORIZED REPRESENTATIVE, Jim Thyden
California Joint Powers Insurance Authority is a joint powers authority pursuant to Article 1 (commencing with Section 6500) Chapter 5 of Division 7 of Title 1 of the California
Government Code.
EVIDENCE OF COVERAGE July 12, 2022 6:16 PM
ADDITIONAL COVERAGE NOTES
Mobile Source Air Pollution agreement for grant funding. Mobile Source Air Pollution agreement for grant funding
CC LIST