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Insurance Certificates 2023/25 Welbe HealthRE: INSURANCE REVIEW eCCvQtCIH�Iv C:A€.IFs)IZNI:1 - Insurance Certificate of Liability for Welbe Health, LLC will be offering FREE a11 -- inclusive health program information to the community. 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 4/30/2024 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. Laurie McGinley 5/8/2024 78495 Calle Tampico 1 La Quint&, Ealy ; . '_ „I: i /RI,1 p I. k , / A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 4/30/2024 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 Marsh & McLennan Agency LLC Marsh & McLennan Ins Agency LLC Treat Boulevard #950 Walnut Creek CA 94597 License#: OH18131 CONTACT NAME: Felicia MCAroy PHONE FAX (A/C, No, Ext): 925-482-9337 (A/C, No): 925-482-9390 E -M1255 ADDRESS: Felicia.McAroy@MarshMMA.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Columbia Casualty Company 31127 INSURED WELBEHEALT Welbe Health LLC 440 N BARRANCA AVE #4051 Covina CA 91723 INSURER B : American Casualty Company of Reading PA 20427 INSURER C : 4/1/2025 INSURER D : $ 1,000,000 INSURER E : X INSURER F : COVERAGES CERTIFICATE NUMBER: 1139261636 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 TYPE OF INSURANCE INSD DDL NSD SWUBR VD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 6057359426 4/1/2024 4/1/2025 EACH OCCURRENCE $ 1,000,000 X CLAIMS -MADE OCCUR DAMAGE PREM SESO(Ea occur ence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY x SCHEDULED AUTOS NON -OWNED AUTOS ONLY 6057359457 4/1/2024 4/1/2025 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6057359443 4/1/2024 4/1/2025 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENT ON $ 10.000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liability 6057359426 4/1/2024 4/1/2025 Each Claim Aggregate $1,000,000 $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta is included as Additional Insured (General Liability), per the attached. Insurance is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78-495 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 REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURED: Welbe Health LLC POLICY#: 6057359426 CNA POLICY PERIOD: 04/01/2024 TO 04/01/2025 Aging Services Healthcare Primary Glossary A. it incorporates insured product or insured work that is known or thought to be defective, deficient, inadequate or dangerous; or B. the Named Insured has failed to fulfill the terms of a contract or agreement; if such property can be restored to use by the repair, replacement, adjustment or removal of insured product or insured work; or the Named Insured's fulfilling the terms of the contract or agreement. INCIDENT Incident means: A. an act, error or omission in the providing of professional services; or B. any violation of rights of residents. INSURED Insured means any Named Insured and, A. with respect to coverage under the Professional Liability Coverage Part: 1. the Named Insured's executive officer, employee, or stockholder but solely with respect to professional services performed on the Named Insured's behalf. However, as respects an executive officer, employee, or stockholder who is an intern, resident, physician, surgeon, dentist, nurse anesthetist, nurse midwife, podiatrist or chiropractor, such executive officer, employee or stockholder is an Insured but solely to the extent they are rendering Good Samaritan services or administrative services on the Named Insured's behalf. 2. the Named Insured's administrator, including the Named Insured's Medical Director, but solely with respect to the rendering of Good Samaritan Services or administrative services performed on the Named Insured's behalf. In addition, the Named Insured's Medical Director is an Insured with respect to the rendering of healthcare services by such Medical Director but solely to the extent such healthcare services are rendered in the attending physician's absence and on an emergency basis. 3. beauticians and barbers who are not the Named Insured's employees but who are invited onto an Insured Location by the Named Insured to perform beauticians and barbers services and only while performing beauticians and barbers services at the Insured Location for the Named Insured. 4. any person or organization to whom or to which the Named Insured is obligated by virtue of a written contract or agreement: a. to add to this policy as an additional insured for its liability; and b. to hold harmless or indemnify such person or organization, but such person or organization is an insured exclusively for the vicarious liability imposed upon such person or organization because of acts, errors or omissions in the rendering of covered professional services by the Named Insured, and only to the extent of the limits of insurance required by such contract or agreement, not to exceed the limits of insurance of this policy. However, this provision does not apply: i. unless the written contract or agreement has been executed prior to the act, error or omission in the rendering of professional services upon which the claim is based. The contract or agreement will be considered executed when the Insured's performance begins, or when it is signed, whichever happens first; or ii. to any Newly Acquired or Newly Formed Entity unless the Insurer agrees to provide coverage to such newly acquired or newly formed entity and such entity is listed in a subsidiary endorsement; or iii. to any person or organization for its liability arising out if its own acts, errors or omissions. Form No: CNA84658XX (01-2016) Glossary Page: 7 of 15 Underwriting Company: Columbia Casualty Company, 151 N Franklin St, Chicago, IL 60606 © Copyright CNA All Rights Reserved. Policy No: PLC 6057359426 Policy Effective Date: 04/01/2024 Policy Page: 29 of 89 CNA Aging Services Healthcare Primary Glossary Further, where required by such written contract or agreement, coverage for such person or organization shall be primary and non-contributory as respects any other insurance policy issued to such additional insured. Otherwise the section entitled OTHER COVERAGE in the COMMON TERMS AND CONDITIONS applies. B. with respect to coverage under the General Liability Coverage Part: 1. the Named Insured's executive officer but only with respect to the conduct of the Named Insured's business; or 2. the Named Insured's stockholders, but only with respect to their liability as stockholders; 3. the Named Insured's employee (other than an executive officer), but only for acts within the scope of their employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business. However, none of these employees is an Insured for: a. bodily injury or personal and advertising injury: i. to the Named Insured, to a Named Insured's executive officers, or to a co -employee while such injured person is either in the course of his or her employment or performing duties related to the conduct of the Named Insured's business; ii. to the spouse, domestic partner, child, parent, brother or sister of such injured person as a consequence of paragraph i. above; or iii. for which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraphs i. or ii. above. b. property damage to property: i. owned, occupied or used by, ii. rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by, iii. Named Insured, any of its employees or executive officers. 4. any person (other than the Named Insured's employee), or any organization while acting as the Named Insured's real estate manager. 5. any person or organization having proper temporary custody of a natural person Named Insured's property if he or she dies, but only: a. with respect to liability arising out of the maintenance or use of that property; and b. until such Named Insured's legal representative has been appointed. 6. any person or organization to whom or to which the Named Insured is obligated by virtue of a written contract, agreement or permit: a. to add to this policy as an additional insured for its liability; and b. to hold harmless or indemnify such person or organization, but such person or organization is an insured exclusively for bodily injury or property damage arising out of an occurrence, or personal and advertising injury arising out of an offense, for which such person or organization is vicariously liable because of acts or omissions committed by the Named Insured and only to the extent of the limits of insurance required by such contract or agreement, not to exceed the limits of insurance of this Policy. However, coverage under this provision does not apply: Form No: CNA84658XX (01-2016) Glossary Page: 8 of 15 Underwriting Company: Columbia Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: PLC 6057359426 Policy Effective Date: 04/01/2024 Policy Page: 30 of 89 © Copyright CNA All Rights Reserved. CNA Aging Services Healthcare Primary Glossary i. unless the written contract or agreement has been executed, or the permit has been issued, prior to the bodily injury, property damage or offense. The contract or agreement will be considered executed when the Insured's performance begins, or when it is signed, whichever happens first; or ii. to any person or organization: (a) for bodily injury, property damage, or personal and advertising injury arising out of its own acts or omissions; or (b) included as an Insured by an endorsement issued by the Insurer and made a part of this policy. Further, where required by such written contract or agreement, coverage for such person or organization shall be primary and non-contributory as respects any other insurance policy issued to such additional insured. Otherwise the section entitled OTHER COVERAGE in the COMMON TERMS AND CONDITIONS applies. C. with respect to coverage under the Employee Benefits Liability Coverage Part: 1. the Named Insured's executive officer, but only for the administration of the Named Insured's employee benefit program; or 2. the Named Insured's employee authorized to administer its employee benefit program; or 3. any person, organization or employee having proper temporary authorization to administer the Named Insured's employee benefit program, but only until an authorized legal representative is appointed on behalf of the Named Insured. INSURED CONTRACT Insured contract means: A. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, explosion, smoke or leaks from automatic fire protective systems to premises while rented to the Named Insured or temporarily occupied by the Named Insured with permission of the owner is not an insured contract; B. a sidetrack agreement; C. any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; D. an obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; E. an elevator maintenance agreement; F. that part of any other contract or agreement pertaining to the Named Insureds business (including an indemnification of a municipality in connection with work performed for a municipality) under which the Named Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. However, paragraph F. does not include that part of any contract or agreement: 1. that indemnifies a railroad for bodily injury or property damage arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; 2. that indemnifies an architect, engineer or surveyor for bodily injury or property damage arising out of: a. preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or Form No: CNA84658XX (01-2016) Glossary Page: 9 of 15 Underwriting Company: Columbia Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: PLC 6057359426 Policy Effective Date: 04/01/2024 Policy Page: 31 of 89 © Copyright CNA All Rights Reserved. ACG'RL'® CERTIFICATE OF LIABILITY INSURANCE �----- 12/16/2024 DATE (MM/DD/YYYY) 5/6/2024 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 Insurance Brokers, LLC CA License # OB99399 400 Capitol Mall Avenue, Suite 2600 Sacramento CA 95814 (213) 689-0550 CONTACT NAME: PHONE FAX (A/CExt)' (A/C, No): E-MAIL° ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Insurance Company of the West 27847 INSURED WelbeHealth, LLC 1505750 405 El Camino Real#248 Menlo Park CA 94025 INSURER B : NOT APPLICABLE INSURER C : INSURER D : $ XXXXXXX INSURER E : INSURER F : CLAIMS -MADE COVERAGES WeHe03 CERTIFICATE NUMBER: 20558903 REVISION NUMBER: XXXXXXX 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 NSD SUBR SWVD POLICY NUMBER POLICY EFF POLICY EFF (MM/DD/YYYY) POLICY EXP POLICY EXP (MM/DD/Yl'YY) LIMITS COMMERCIAL GENERAL LIABILITY NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX CLAIMS -MADE OCCUR DAMAGE TO PREMISES (Ea occurrence) $ XXXXXXX MED EXP (Any one person) $ XXXXXXX PERSONAL & ADV INJURY $ XXXXXXX GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ XXXXXXX OTHER: $ AUTOMOBILE LIABILITY NOT APPLICABLE CO aBI dEDt) SINGLE LIMIT (EaANY $ XXX�CS�XX AUTO BODILY INJURY (Per person) $ XXXXXXX OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) $ XXXXXXX $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS -MADE AGGREGATE $ XXXXXXX DED RETENTION $ $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y WSA 5063275 03 12/16/2023 12/16/2024 X PER STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Y N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Named Insured: Inland Empire PACE CERTIFICATE HOLDER CANCELLATION See Attachments 20558903 City of La Quinta 46805 Dune Palms Road 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 REPRESENTATIVE ©1988-2N5 ACORD CORP - TION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AttWORKBEIS1COMIPENWeTtiONtAND IHNIPEOYERS LIABILITY INSURANCE POLICY WC 99 06 37 (Ed. 5-02) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the schedule. The additional premium for this endorsement shall be 5 % of the California Workers' Compensation premium otherwise due on such remuneration, subject to a minimum premium of $ 50. Schedule Person or Organization CITY OF LA QUINTA 46805 DUNE PALMS ROAD, LA QUINTA CA 92253 Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/01/2024 Policy No. WSA 5063275 03 Insured Endorsement No. 008 WELBEHEALTH, LLC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 37 (Ed. 5-02) Attachment Code: D568359 Master ID: 1505750, Certificate ID: 20558903 To whom it may concern: In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance. To ensure electronic delivery for future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 20558903. • Email: PacificeDelivery@lockton.com • Phone: (213) 689-2300 If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above. The above inbox is for automating electronic delivery of certificates only. Please do NOT send future certificate requests to this inbox. Thank you for your cooperation and willingness in reducing our environmental footprint. Lockton Insurance Brokers, LLC — Pacific Series Lockton Insurance Brokers, LLC License #0F15767 777 S Figueroa Street, 52nd Fl / Los Angeles, CA 90017-5524 213-689-0065 / FAX: 213-689-0550 lockton.com Attachment Code: D638692 Master ID: 1505750, Certificate ID: 20558903 Additional Named Insured WelbeHealth, LLC Sequoia PACE, LLC -HQ Pacific PACE, LLC LA Coast PACE, LLC Welbe Health HC SOCAL, LLC Welbe Health HC NOCAL, LLC Welbe Housecalls, LLC WelBeHealth Bay Area Pace, LLC Stockton PACE, LLC WelbeHealth Atlantic Pace, LLC Stockton PACE Medical Practice PC