Insurance Certificates 2022/23 CDBG - LQ Evidence of Coverage EVIDENCE OF COVERAGE and ADDITIONAL PROTECTED PARTY June 24, 2022 12:00 AM
COVERAGE PROVIDER MEMBER
La Quinta
78-495 Calle Tampico
La Quinta, CA 92253-2839
7607777123
California Joint Powers Insurance Authority
8081 Moody Street
La Palma CA 90623
www.cjpia.org
Contact Name: Jim Thyden, Insurance Programs Manager
Phone: (562) 467-8700 Laurie McGinley
lmcginley@laquintaca.gov
7607777123
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 COVERAGE 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 ERRORS & OMISSIONS EACH OCCURRENCE $1,000,000
X EMPLOYMENT PRACTICES
MOC LP 7/1/21 – 7/1/23
FIRE DAMAGE (Any one fire)$ 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
WC STATUTORY
LIMITS $ N/A7/1/21 – 7/1/23
EMPLOYER’S LIABILITY $1,000,000
ADDITIONAL REMARKS
When required by written agreement, the California Joint Powers Insurance Authority agrees to include the Evidence Holder as an Additional
Protected Party under the Memorandum of Coverage Liability Program, subject to the above-stated limits, but only for “Occurrences” caused by the
activity described in the written agreement between the Member and the Evidence Holder for the date(s) and time(s) specified in the written
agreement. If the written agreement requires, coverage shall be primary and non-contributory. If the written agreement requires, subrogation is
waived.
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
Riverside County HWS, Community Solutions Division
3403 10th St.
Suite 300
Riverside, CA 92501
Blanca Higuera
BlHiguera@Rivco.org
951-955-6007
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 and ADDITIONAL PROTECTED PARTY June 24, 2022 12:00 AM
ADDITIONAL PROTECTED PARTY
Riverside County Housing and Workforce Solutions
ADDITIONAL COVERAGE NOTES
CDBG Block Grant 2021-2022
Use of the 2021/22 Community Development Block Grant Funds for the City's ADA Improvement project and for the Boys & Girls Club
Fully Executed Agreement will be provided to you as soon as it is received. The County will not sign the Agreement until EOC is provided.
CC LIST