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Insurance Certificates 2024/25 Box of KittensDATE (MM/DDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 03/26/2024 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 CONTACT NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CAPHONE FAX AIC 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 EACH OCCURRENCE INSURED INSURER B: Box of Kittens 30 Clancy Lane Estates INSURER C Rancho Mirage, CA 92270 INSURER D PREM SESODAMAGE TEa occur RENTEence $ 100,000 INSURER E: INSURER F: $ 5,000 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 PREM SESODAMAGE TEa occur RENTEence $ 100,000 MED EXP (Any one person) $ 5,000 A Y P100.264.263.4 05/10/2024 05/10/2025 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 HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 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 I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City Of La Quinta is an additional insured. The Hiscox General Liability Policy is Primary and Non -Contributory, subject to the policy's terms and conditions. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE La Quinta, CA 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 Aeo HISCOX Policy Number: P100.264.263.4 Named Insured: Box of Kittens Endorsement Number: 19 Endorsement Effective: 5/10/2024 Hiscox Insurance Company Inc. 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. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 auranesa Insurance 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, 2024 to Jan 19, 2025 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, 2024, this Offer to Renew becomes null and void. Your coverage expires Jul 19, 2024 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): Questions? If you'd like to make a change to your policy, please contact us at renewals.us(a)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, 2024 01:32 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company PERSONAL Renewal Declaration effective v ffi10'WJff11e,.fJff AUTOMOBILE POLICY Jul 19, 2024 117= face 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, 2024 to Jan 19, 2025 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 one (1) vehicle(s) is $732.02. Refer to the breakdown of premiums below. Description of Owned Vehicle(s) Vehicle Year Make Model Vehicle Identification Number Premium per Vehicle($) 1 2019 Tesla MODEL 3 STANDARD/ 5YJ3E1EA9KF428952 $732.02 STANDARD PLUS/MID/ LONG Premium Subtotal for Vehicles $732.02 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 ($) 1 121.31 71.74 35.51 69.52 288.55 143.44 1.95 732.02 Jun 18, 2024 01:32 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company PERSONAL Renewal Declaration effective v ffi F, FA AUTOMOBILE POLICY Jul 19, 2024 /nsurffgCe 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, 2024 to Jan 19, 2025 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 28 Pleasure 92270 1,4 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 1 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 Jun 18, 2024 01:32 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company PERSONAL Renewal Declaration effective v ffi10'Wjffjje,.fjff AUTOMOBILE POLICY Jul 19, 2024 117= face 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, 2024 to Jan 19, 2025 the Named Insured as stated herein 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 - Designated Additional Person To Receive Notice of Cancellation or Nonrenewal (CADAPE 09 21), Personal Auto Policy - California (CAPAP 09 21), California Notice of Designated Additional Person to Receive Notice of Cancellation (CADAP 09 21) ADDED: Vehicle Identification Cards (VID 1), Disclosure of Fees - California Auto (CADCFA 04 22), Available Coverages & General Coverage Descriptions (CACOV 09 21), Minimum Liability Coverage Limits and Available Discounts (CADIS 09 21) Jun 18, 2024 01:32 CT "Wawanesa Insurance" is a trademark of Wawanesa General Insurance Company PERSONAL Renewal Declaration effective -- ffiauranesa AUTOMOBILE POLICY Jul 19, 2024 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, 2024 to Jan 19, 2025 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, 2024 01:32 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 —PC))(- 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 M5 . 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 5 -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. 6l- (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 D Citi Ler- Print Name of Declarant 121>0) 0E Print Name of Company