Insurance Certificates 2023/24 Box of KittensACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
1 08/15/2023
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
CONTACT
NAME:
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA
PHONE FAX
A/C No Ext : (888) 202-3007 A/C No):
5 Concourse Parkway
E-MAIL
Suite 2150
ADDRESS: contact@hiscox.com
INSURER(S) AFFORDING COVERAGE
NAIC#
Atlanta GA, 30328
INSURER A: Hiscox Insurance Company Inc
10200
INSURED
INSURER B :
Box of Kittens
30 Clancy Lane Estates
INSURER C
Rancho Mirage, CA 92270
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE � OCCUR
IRE M SESODAMAGE TEa occur RENTEence
$ 100,000
MED EXP (Any one person)
$ 5,000
A
Y
P100.264.263.3
05/10/2023
05/10/2024
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY PRO ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$ S/T Gen. Agg.
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? ❑
N / A
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of La Quinta, its officers, officials, employees and agents.
78495 Calle Tampico
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
La Quinta, California 92253
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
n1A
HISCOX
Policy Number:
P100.264.263.3
Named Insured:
Box of Kittens
Endorsement Number:
14
Endorsement Effective:
05/10/2023
Hiscox Insurance Company Inc.
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
A. 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, pro-
vided:
1. you have agreed in a written contract or
agreement to add such additional insured to
a policy providing the type of coverage af-
forded by this policy; and
2. you have agreed in a written contract or
agreement with such additional insured that
this insurance would be primary and would
not seek contribution from any other insur-
ance available to the additional insured.
CGL E5581 CW (03/16) Includes copyrighted material of Page 1 of 1
Insurance Services Office, Inc., with its permission
u/auranesa
MSUMMe
ANNDEE L LASKOE
30 CLANCY LANE ESTATES
RANCHO MIRAGE CA 92270
PERSONAL AUTOMOBILE POLICY
OFFER TO RENEW
COVER PAGE
WAWANESA INSURANCE
PO BOX 82867
SAN DIEGO CA 92138-9492
TELEPHONE: 800-640-2920
Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of
10418360 918101-1 1 From Jul 19, 2023 to Jan 19, 2024 the Named Insured as stated herein
Thank you for your continued business with Wawanesa General Insurance Company ("Wawanesa Insurance").
We appreciate the opportunity to provide you with quality coverage and peace of mind knowing that we strive to provide
the most dependable coverage at the lowest price possible.
Please review your Renewal Declaration. This Declaration is an offer only. Payment of the premium renews your policy
for the period shown. If your payment is not received before Jul 19, 2023, this Offer to Renew becomes null and void.
Your coverage expires Jul 19, 2023 at 12:01 A.M.
If you are responsible for the payments due on this policy, please refer to the invoice statement (enclosed or mailed
separately). The invoice statement also includes additional payment information, such as our flexible payment options.
You should also carefully review your coverage limits for Bodily Injury Liability and Property Damage Liability to ensure
they are appropriate for your lifestyle, income, and risk tolerance. If you are found legally responsible for damages which
exceed your Liability coverage limits, personal assets such as your savings or even your home could be at risk. Industry
organizations and consumer groups recommend limits higher than what the law requires.
By accepting this policy and the Declaration pages you consent to be legally bound by the provisions of the policy,
including the coverage limits, options and endorsements.
Important Information (This page is part of your Policy Declaration):
After several years without increasing rates for all customers, we are now finding it necessary to make adjustments to
cover the higher costs of providing insurance. Several factors are contributing to the significant rise in auto insurance
rates, including inflation, increased medical costs, higher repair costs, and more serious injuries resulting from accidents.
We want to apologize for the effect this increase may have on you personally. We want to assure you that despite this
change we remain competitively priced because insurance companies throughout the industry are also facing these cost
increases and they too are raising their rates accordingly, or soon will be.
Rest assured that we are always here to assist you, whether you need help with an accident, have questions about your
coverage, or want to learn more about the factors contributing to the increase in auto insurance rates nationwide. At
Wawanesa, we truly appreciate your decision to entrust us with your insurance needs and are committed to providing you
with the protection and service you've come to expect from us. Thank you for your understanding and continued business.
Please review the attached letter for more details and to help you understand these changes.
Questions? If you'd like to make change to your policy, please contact us at renewals.us@wawanesa.com and provide
your name and policy number, or call our office and our Knowledgeable Customer Service Representatives will be happy
to assist you.
Did you know? For more information regarding our products and services, visit our website at wawanesa.com. You can
also submit changes to your policy, report a claim, or receive an insurance quote in minutes.
Thank you for being a valued customer.
Earning Your Trust Since 1896
Jun 18, 2023 00:54 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
PERSONAL Renewal Declaration effective
-- 1610.ranesa AUTOMOBILE POLICY Jul 19, 2023
/assurance DECLARATION
Supersedes any previous declaration bearing the
same policy number.
ANNDEE L LASKOE
30 CLANCY LANE ESTATES
RANCHO MIRAGE CA 92270
WAWANESA INSURANCE
PO BOX 82867
SAN DIEGO CA 92138-9492
TELEPHONE: 800-640-2920
Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of
10418360 918101-1 1 From Jul 19, 2023 to Jan 19, 2024 the Named Insured as stated herein
Named Insured's Phone Number: 760-844-3222 Named Insured's Email Address: anndeelaskoe@yahoo.com
Your 6 month premium for two (2) vehicle(s) is $1,495.82. Refer to the breakdown of premiums below.
Description of Owned Vehicle(s)
Vehicle
Year
Make
Model
Vehicle Identification Number
Premium per Vehicle($)
1
2019
Tesla
MODEL 3 STANDARD/
5YJ3E1EA9KF428952
$598.69
STANDARD PLUS/MID/
LONG
2
2021
Jeep
WRANGLER JL UN PHEV
1C4JJXP68MW765884
$897.13
4XE SAH/HGHALT AWD
Premium Subtotal for Vehicles
$1,495.82
Insurance is provided only with respect to the coverages for which a Premium is stated, subject to all conditions
of the policy.
Coverage and Limits of Liability
See Policy for Coverage Details
Bodily Injury Liability
$100,000 per person/$300,000 each occurrence
Property Damage Liability
$50,000 each occurrence
Medical Payments
$5,000 each person
Comprehensive
$500 deductible
Collision
$500 deductible
Uninsured/Underinsured Motorists Protection
$100,000 per person/$300,000 each occurrence
Uninsured Motorists Collision Deductible
Waiver
Total Premium Per Vehicle ($)
All premiums listed are for the full 6-month term.
Premiums per Vehicle ($)
1
2
102.46
129.46
57.46
72.55
20.40
22.84
67.93
135.11
264.32
435.62
84.44
99.87
1.68
1.68
598.69
897.13
Jun 18, 2023 00:54 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
PERSONAL Renewal Declaration effective
Maaranesa AUTOMOBILE POLICY Jul 19, 2023
/nsuraace DECLARATION
Supersedes any previous declaration bearing the
same policy number.
ANNDEE L LASKOE
30 CLANCY LANE ESTATES
RANCHO MIRAGE CA 92270
WAWANESA INSURANCE
PO BOX 82867
SAN DIEGO CA 92138-9492
TELEPHONE: 800-640-2920
Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of
10418360 918101-1 1 From Jul 19, 2023 to Jan 19, 2024 the Named Insured as stated herein
Vehicle Rating Information Chart
Vehicle Description
Previous
Estimated
Rated
Vehicle
Zip Code
Discounts
# of Traffic
# of
Estimated
Annual
Driver No.
Usage
Applied
convictions
Chargeable at -
Annual
Mileage Used
of Years
(See code
for driver
fault accidents
Mileage
for Rating
Licensed
definition
rated on this
for driver rated
below)
vehicle
on this vehicle
2019 Tesla
2200
2200
27
Pleasure
92270
1, 2, 4
0
0
2021 Jeep
8000
8000
33
Pleasure
92270
1, 2, 4
0
0
Discount Codes: 1. Good Driver 2. Multi -Vehicle 3. Mature Driver 4. Loyalty or Affinity Group
Important Information Regarding Estimated Annual Mileage:
State law requires us to periodically verify the miles you plan to drive annually. Please review the estimated annual
mileage for each vehicle listed above. If the amount provided does not reflect your anticipated mileage in the next 12-
months, please contact us so we can update your policy. We may ask for additional information to support your estimate.
If we don't hear from you, the estimated mileage shown will be used for your upcoming renewal. Depending on the
information you provide, we may use a mileage amount different than your estimate to set your upcoming term's premium.
Driver(s)
Driver Name
Principal Operator of Vehicle Number
Occasional Operator of Vehicle Number
ANNDEELLASKOE
2
DAVID HUGHES
1
Exclusion of Named Driver(s)
Excluded Driver(s) Relationship to Insured
Jett Udcoff Child
Additional Interest(s)
Lienholder(s)
Vehicle 1 Wells Fargo
PO BOX 29710
Phoenix AZ 85038
Vehicle 2 Ally Smart Lease
9715 E Firestone Blvd
Downey CA 90241
Jun 18, 2023 00:54 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
PERSONAL Renewal Declaration effective
-- 1610.ranesa AUTOMOBILE POLICY Jul 19, 2023
/assurance DECLARATION
Supersedes any previous declaration bearing the
same policy number.
ANNDEE L LASKOE
30 CLANCY LANE ESTATES
RANCHO MIRAGE CA 92270
WAWANESA INSURANCE
PO BOX 82867
SAN DIEGO CA 92138-9492
TELEPHONE: 800-640-2920
Policy Number Account Number Policy Period 12:01 A.M. standard time at the address of
10418360 918101-1 1 From Jul 19, 2023 to Jan 19, 2024 the Named Insured as stated herein
Additional Interest(s)
Leasing Company
Vehicle 2
Ally Smart Lease
9715 E Firestone Blvd
Downey CA 90241
POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US.
REMAIN IN EFFECT (Refer to prior Policy Packet(s) for documents not attached.):
California Notice of Designated Additional Person to Receive Notice of Cancellation (CADAP 09 21), California - Designated Additional
Person To Receive Notice of Cancellation or Nonrenewal (CADAPE 09 21), Personal Auto Policy - California (CAPAP 09 21)
ADDED:
Important Information - Price Increase Notice (RCN 05 23), Disclosure of Fees - California Auto (CADCFA 04 22), Vehicle Identification
Cards (VID 1), Minimum Liability Coverage Limits and Available Discounts (CADIS 09 21), Available Coverages & General Coverage
Descriptions (CACOV 09 21)
Jun 18, 2023 00:54 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
--- PERSONAL Renewal Declaration effective
�-- Ivaaranesa AUTOMOBILE POLICY Jul Declaration
2023
Insurance DECLARATION
Supersedes any previous declaration bearing the
same policy number.
ANNDEE L LASKOE
30 CLANCY LANE ESTATES
RANCHO MIRAGE CA 92270
Policy Number Account Number Policy Period
10418360 918101-1 From Jul 19, 2023 to Jan 19, 2024
Important Information - Consumer Services - California
WAWANESA INSURANCE
PO BOX 82867
SAN DIEGO CA 92138-9492
TELEPHONE: 800-640-2920
12:01 A.M. standard time at the address of
the Named Insured as stated herein
Because of the complicated nature of the insurance business, there may be times when you will have questions
regarding your coverage or the premium charged, or a problem may arise with your policy. If this occurs we urge
you to contact our Customer Service Department to answer your questions or resolve your problem. If after this
you are still not satisfied, you may contact the following state agency:
California Department of Insurance, Consumer Services Division, 300 South Spring Street, South Tower, Los
Angeles, California 90013
Toll free number: 1-800-927-HELP
Website: www.insurance.ca.gov
YOUR PRIVACY RIGHTS. We use information about you to provide you with insurance and adjust claims. We collect this
information from you as well as from other sources. In certain circumstances, we may disclose this information to third
parties without your consent. You have the right to access and correct any information about you that we collect. For more
details about our privacy practices, please visit us at www.wawanesa.com. To receive a copy of our full privacy notice call
us toll -free at 1-800-640-2920, or write to us at the address shown above.
Visit wawanesa.com/online to view information about your policy or contact Customer Service for additional
assistance.
Online Service: Make payments, Our helpful agents are available: Fax: 619-285-2711
check billing activity, update policy Monday to Friday 7:30 am - 7:30 pm Mail: PO Box 82867
details, or view claims information. and Saturday 8:00 am - 4:30 pm San Diego, CA 92138-9492
wawanesa.com/online Phone: 800-640-2920 Email: service.us@wawanesa.com
Jun 18, 2023 00:54 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company
Declaration of Sole Proprietor
DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO
I declare for the
awarded to 1
B w
S
Individual or Organization Name
of inducing the Cituf La Quinta to go forward with any contracts
as follows:
I am the authorized representative of P (g )(- Or- k-'- j rrCJJS.
an independent contractor for the purposes of the California Workers' Compensation and Labor
laws. This organization will hire no employees other than the parents, spouses, or children of its
board members for work required for any bid or contract awarded to
-o X er- i< t M 5 . All worked required will be
performed personally and solely by me, other board members of the organization, their parents,
spouses or children, or persons who perform voluntary service without pay to the organization.
If, however, the organization shall ever hire employees to perform this contract or any portion
thereof, the organization shall obtain Workers' Compensation Insurance and provide proof of
Workers' Compensation Insurance coverage to the City of La Quinta. If the organization shall
ever hire a subcontractor to perform this contract or any portion thereof, and the subcontractor
has employees, then the organization shall require its subcontractor to obtain Workers'
Compensation Insurance Coverage, or the organization shall obtain Workers' Compensation
Coverage for that subcontractor's employees.
This document constitutes a declaration by the organization against its financial interest, relative
to any claims it should assert under the California Workers' Compensation and/or Labor laws
against City of La Quinta relating to any bid or contract awarded to
6 ox or- k1fire>,1S
The organization will defend, indemnify and hold harmless the City of La Quinta from any and
all claims and liability, including Workers' Compensation claims and liability that may be
asserted or established by any party in the event the organization hires an employee in violation
of this addendum, and the organization will further indemnify the City of La Quinta for all
damages the City of La Quinta thereby suffers.
I agree thatthese declarations shall constitute an addendum to any bid or contracts awarded to
Date
Authorized Representative
Declaration Regarding California Workers' Compensation
You are required to complete this form because you have not filed a certificate regarding workers'
compensation insurance with City of La Quinta. California law requires all employers to carry workers'
compensation insurance, even if they have only one employee. If you do not know whether you are
required to carry workers' compensation insurance, find out by contacting the California Department of
Industrial Relations ("DIR"). Information is also available on the DIR's website at httn:/1www.dir.ca.eov.
You should also consult with your attorney, insurance agent or broker, or carrier regarding the specifics
of your situation and your options. If you are subject to the Workers' Compensation Laws of California,
you must promptly file a certificate of Workers' Compensation Insurance with City of La Quinta. if you
have a certificate of self-insurance from the DIR, you must file that certificate with City of La Quinta.
When completing this form, remember that the term "employee" includes clerical persons as well as any
other persons employed by your company including drivers.
ACKNOWLEDGMENT
4�(initial) California Labor Code § 3700 requires employers to carry workers' compensation
insurance or to obtain a certificate from the Director of Industrial Relations demonstrating that the
employer is self -insured. California Labor Code § 3700.5 makes it a criminal offense for an employer to
fail to secure compensation as required by the workers' compensation provisions of the Labor Code.
Violation of Labor Code § 3700 is punishable by a fine of up to $10,000 and/or imprisonment for up to
one year.
6 l (initial) California Labor Code § 3710.1 provides that where an employer fails to provide
compensation required under § 3700, the Director of the Department of Industrial Relations shall issue a
stop order, prohibiting the employer from using employee labor until such time as the employer
complies with the provisions of § 3700. Labor Code § 3710.2 makes it a criminal offense to disregard
such stop orders.
initial) I acknowledge that if evidence is found that contradicts this declaration, City of La Quinta
will promptly notify all relevant state agencies to ensure full insurance compliance required by Workers'
Compensation Laws of California.
��initial) I understand that California Labor Code § 3700 et seq, requires employers to provide
workers' compensation insurance coverage for any employees of my business. I hereby warrant that this
business is exempt from the California Labor Code provisions regarding workers' compensation
insurance because it has no employees.
initial) I agree to hold City of La Quinta and its officers, officials, employees, and agents harmless
for loss or liability which may arise from the failure of my business to comply with the laws of the State
of California regarding workers' compensation insurance.
a—(--+nitial) If 1 hire employees in the future, I will immediately notify City of La Quinta and provide a
certified Workers' Compensation certificate to the City.
CERTIFICATION
I (we) certify under penalty of perjury, under the laws of the State of California, that I (we) have read
and understood the above stated requirements regarding Workers' Compensation and that I(we) am
(are) in compliance. I(we) certify that the forgoing is true and correct.
Executed this 1(0?H day of 405T 2P.2-5at-.."Jt,140MIkWCalifornia
Signature of Declarant
_Alit DC e- Lffs r-
Print Name of Declarant
121>0)0E
Print Name of Company