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Insurance Certificates 2022/23 - AARP (Volunteer Org) - Tax Servicesit RE: INSURANCE REVIEW Cv itlK.rCv CALIFORNIA Insurance Certificate of Liability with Additional Insured and Primary and Non -Contributory endorsement pages for American Association of Retired Persons (AARP) for AARP Volunteer Services Agreement. 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 1 1 -1 8-2022 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: Approved by: Date: List other insurance types such as - molestation, harassment, etc. Monika Radeva 12/2/2022 7B495 Calle Tampico 1 La Unto, California 92253 1160.m./0001 www.laquinfaca.gov ACORa� `� CERTIFICATE OF LIABILITY INSURANCE 7i1i2023 DATE (MMIDD/YYYY) II/I8/2022 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 endorsement(s). PRODUCER Lockton Companies 1801 K Street NW. Suite 200 Washington DC 20006 (202) 414-2400 NAME: CONTACT PHONE NAI( (A/C No FAN' INC. N. E-MAIL ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Arch. Insurance Company 11150 INSUREDAARP 1452074 c/o Lisa Hilton 1 LHilton@aarp.org aarp.org 1562.496.5206 601 E Street NW Washington DC 20049 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CfVFRAP.PS CFRTIFIrATF NI IMRFR• 16404072 REVISION NUMBER: YV V'V - 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. INSSR TYPE OF INSURANCE ADDLTSUBR INcQ I `MD POLICY NUMBER POLICY EFF (MMIDD/YYYYI POLICY EXP (MM/DDIYYYY) LIMITS A COMMERCIAL GENERAL LIABILITY N N 11GPP4936915 7/1/2022 7/1/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1 X OCCUR DAMAGE TO I-N.) PREMISES (Ea toccurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000.000 $ 15,000,000 $ 1,000,000 0E.31 AGGREGATE XPOLICY _ OTHER: LIMIT APPLIES PRO- JE07 PER: LOC GENERAL AGGREGATE PRODUCTS-COMPIOPAGG AUTOMOBILE — UABILITY ANY AUTO OWNED OS ONLY AHIRED AUTOS ONLY AUTOSULED NON -OWNED AUTOS ONLY NOT APPLICABLE COMBINED SINGLE LIMIT {Ea accidentl $ XXXXXXX BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident) $XXXXXXX PROPERTY DAMAGE (Per accident) $ XXXXXXX $ XXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A NOT APPLICABLE PER STATUTE OTH- ER El. EACH ACCIDENT $ XXXXXXX E.L. DISEASE - EA EMPLOYEE $ XXXXXXX E.L. DISEASE - POLICY LIMIT $ XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERMS) REFERENCED CITY OF LA QUINTA is included as additional insured as it respects general liability RE: AARP Tax Aide Program at La Quinta Wellness Center CERTIFICATE HOLDER CANCELLATION 16404072 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 REPRP.Si'ir I ALIVE © 1988-2015 ACORD CORPORATION. II rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number 11GPP4936915 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMON POLICY CHANGE ENDORSEMENT Endorsement No. 012 ARCH INSURANCE COMPANY Named Insured AARP Effective Date: 11-18 — 2 2 12:01 A.M., Standard Time Agent Name LOCKTON COMPANIES, LLC (NORTHEAST SERIES) Agent No. 14055 This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions of coverage unless at the sole request of the insured. COVERAGE PART INFORMATION —Coverage parts affected by this change as indicated by x below. Commercial Property X Commercial General Liability NO CHARGE Commercial Crime Commercial Inland Marine The following item(s): Insured's Name Insured's Mailing Address Policy Number Company Effective/Expiration Date Insured's Legal Status/Business of Insured Payment Plan Premium Determination Additional Interested Parties Coverage Forms and Endorsements Limits/Exposures 1 Deductibles Covered Property/Location Description [I Classification/Class Codes Rates Underlying Exposure/Insurance is (are) changed to read {See Additional Page(s) } THE FOLLOWING FORM(S) HAS BEEN ADDED: CG 20 26 12-19 ADDL INSD - DESIGNATED PERSON OR ORG ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME The above amendments result in a change in the premium as follows: This premium does not include taxes and surcharges. No Changes pi To be Adjusted at Audit Additional NO CHARGE ReturnNO CHARGE Tax and Surcharge Changes Additional Return Countersigned By: AUTHORIZED AGENT FAIC-SKLBUS-COCHG (6/01) COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 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 LIQUOR 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 (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. CG20011219 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 11GPP4936915 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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): CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 1 of 1 © Insurance Services Office, Inc., 2018 CG 20 26 12 19