Insurance Certificates 2023/24 Riverside County Dept. of Social ServicesINSURANCE REVIEW
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FORNIA
RE: Insurance Certificate of Liability with Additional Insured pages for Riverside
County Department of Social 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
July 27, 2023
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:
F—]$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:
F-1$1,000,000 per occurrence/loss
Other:
List other insurance types such as - molestation, harassment, etc.
Approved by:
Date:
L
RIVCO AR
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CERTIFICATE OF INSURANCE OR SELF-INSURANCE
THIS IS TO CERTIFY THAT THE SELF -INSURED COVERAGE LISTED BELOW IS CURRENTLY IN EFFECT 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 COVERAGE AFFORDED BY THIS CERTIFICATE DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH CERTIFICATE.
COVERAGE PROVIDED IS SUBJECT TO THE TERMS AND CONDITIONS OF THE EXCESS POLICY.
Type of Coverage
Company and
Policy Period
Limits of Liability
Policy Number
Bodily Injury/Property Damage
Commercial General
Self -Insured
07/01/2023
$1,000,000 Combined
Liability Including
to
Single Limit Per
Vehicle Liability and
07/01/2024
Occurrence with No
Property
Aggregate Limit
Workers'
Permissibly
07/01/2023
$2,000,000 Per Occurrence
Compensation
Self -Insured
to
with No Aggregate Limit
& Employers'
07/01/2024
Liability
The County of Riverside certifies that the above self -insured program is in effect as respect to:
Compliance requirement to participate in community outreach events for the City of La Quinta.
Certificate Holder
Cancellation
City of La Quints
In the event of cancellation of the self-insurance program or
Attn: Caroline Doran
policy designated below, it is the intent of the County of
78495 Calle Tampico
Riverside to mail 30 days' prior notice thereof.
La Quinta, CA 92253
This certificate is not valid unless signed by an authorized representative of the County of Riverside, Risk Management Division
Date: July 27, 2023
Lari Camarra
cc: Elizabeth S. Martinez, Comm. Program Specialist, DPSS - ASD
® P.O. Box 1210, Riverside, CA92502 `,(951)955-3540 Am(951)955-4027 ®riskmanagement@rivco.org
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July 27, 2023
Re: ADDITIONAL COVERED PARTY AMENDATORY ENDORSEMENT
The County of Riverside is self -insured under the State of California Government Code Section 990.4.
The County meets all State requirements for self -insured and complies with all State of California rules
and regulations for self -insured entities.
It is agreed that the "Covered Party, Covered Persons or Entities" section of the Memorandum is
amended to include the person or organization named on the Certificate of Coverage, but only with
respect to liability arising out of premises owned by or rented by the County of Riverside, or operations
performed by or on behalf of the County of Riverside or such person or organization so designated.
Coverage provide under this endorsement is limited to the lesser of the limits stated on the Certificate of
Coverage of the minimums limits required by contract.
ADDITIONAL COVERED PARTY: City of La Quinta
AS RESPECTS: Compliance requirement to participate in community outreach events for the City of La
Quinta.
Best regards,
Lari Camarra
Risk Manager
LC/d r