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Insurance Certificates 2024/25 Desert Healthcare District - Flu Shot ClinicINSURANCE REVIEW CuQa�&a F ORN A RE: Insurance Certificate of Liability with Additional Insured and Primary and Non -Contributory endorsement pages for Desert Health Care District Foundation for IHH 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 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 P✓ Workers' Compensation Endorsement with Waiver of Subrogation ❑ Sole Proprietor Professional Liability (Errors and Omissions): F✓ 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. Oscar Mojica 9/24/2024 Issue Date NON-MEMBER'S CERTIFICATE OF COVERAGE 10/23/2024 Provider Special District Risk Management Authority T �'Ik� 1112 Street, Suite 300 Sacramento, California 95814 SDRMA 800.537.7790 www.sdrma.org Member Desert Healthcare District Member Number: 7182 1140 North Indian Canyon Drive Certificate Number: 64 Palm Springs, California 92262 This is to certify that coverages listed below have been issued to the Member named above for the period indicated. This certificate is not an insurance policy or an agreement of coverage and does not amend, extend or alter the coverage afforded by the agreements listed herein. 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 described herein is subject to all the terms, exclusions, and conditions of the specific coverage document. This certificate of coverage evidences the limits of liability in effect at the inception of the agreements shown; limits shown may have been reduced by paid claims. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. Type of Coverage Policy Number Effective Date Expiration Date Limits Auto Liability LCA-SDRMA-202425 7/1/2024 7/1/2025 Auto Bodily Injury Per Occurrence $1,000,000 Auto Property Damage $1,000,000 General Liability LCA-SDRMA-202425 7/1/2024 7/1/2025 Employee/Public Officials E & 0 Per Occurrence $1,000,000 Regarding the the Hold Harmless Agreement for the vaccine clinic on 10/23/24. Cancellation: Should any of the above-described policies be cancelled before the expiration dates thereof, the issuing company will endeavor to mail 30 days written notice to the above-named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. Certificate Dates: Effective Date Expiration Date Certificate Type: Additional Covered Party ❑ Loss Payee 10/23/2024 10/24/2024 ❑x Evidence of Coverage Certificate Holder City of La Quinta Attention: Caroline Doran Brian Kelley, MBA, ARM 78495 Calle Tampico La Quinta. CA 92253 Chief Executive Officer Issue Date NON-MEMBER'S CERTIFICATE OF COVERAGE 10/23/2024 Provider Special District Risk Management Authority T �'Ik� 1112 Street, Suite 300 Sacramento, California 95814 SDRMA 800.537.7790 www.sdrma.org Member Desert Healthcare District Member Number: 7182 1140 North Indian Canyon Drive Certificate Number: 63 Palm Springs, California 92262 This is to certify that coverages listed below have been issued to the Member named above for the period indicated. This certificate is not an insurance policy or an agreement of coverage and does not amend, extend or alter the coverage afforded by the agreements listed herein. 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 described herein is subject to all the terms, exclusions, and conditions of the specific coverage document. This certificate of coverage evidences the limits of liability in effect at the inception of the agreements shown; limits shown may have been reduced by paid claims. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. Type of Coverage Policy Number Effective Date Expiration Date Limits General Liability LCA-SDRMA-202425 7/1/2024 7/1/2025 Bodily Injury Per Occurrence $1,000,000 Property Damage $1,000,000 City of La Quinta and its officers and employees are named as Additional Covered Parties with respect to the Hold Harmless Agreement for the vaccine clinics on 10/23/24 but only to the extent such Additional Covered Party is held liable for the acts or omissions of the Member named above, and not for liability in excess of the amount of coverage required under that Agreement. Cancellation: Should any of the above-described policies be cancelled before the expiration dates thereof, the issuing company will endeavor to mail 30 days written notice to the above-named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. Certificate Dates: Effective Date Expiration Date Certificate Type: Additional Covered Party ❑ Loss Payee 10/23/2024 10/24/2024 ❑Evidence of Coverage Certificate Holder City of La Quinta Attention: Caroline Doran Brian Kelley, MBA, ARM 78495 Calle Tampico La Quinta. CA 92253 Chief Executive Officer SDRMA SPECIAL DISTRICT RISK MANAGEMENT AUTHORITY This endorsement changes the Liability Coverage Agreement. Please read it carefully. COVERAGE PERIOD: 10/23/2024 through 10/24/2024 MEMBER AGENCY Desert Healthcare District 1140 North Indian Canyon Drive Palm Springs, California 92262 1112 I Street, Suite 300 Sacramento, CA 95814-2865 O 916-231-4141 * 800-537-7790 Fax 916-231-4111 Maximizing Protection. Minimizing Risk. ADDITIONAL COVERED PARTY City of La Quinta Attention: Caroline Doran 78495 Calle Tampico La Quinta, CA 92253 This endorsement modifies the Liability Coverage Agreement provided under the following: General Liability - Bodily Injury - LCA-SDRMA-202425 - Per Occurrence - $1,000,000 General Liability - Property Damage - LCA-SDRMA-202425 - Per Occurrence - $1,000,000 It is hereby agreed that this endorsement is added to the Liability Coverage Agreement issued to Desert Healthcare District by Special District Risk Management Authority ("SDRMA") adding the following as an Additional Covered Party: City of La Quinta and its officers and employees are named as Additional Covered Parties with respect to the Hold Harmless Agreement for the vaccine clinics on 10/23/24 but only to the extent such Additional Covered Party is held liable for the acts or omissions of the Member named above, and not for liability in excess of the amount of coverage required under that Agreement. The coverage afforded by this endorsement is afforded only as limited above and provided further that this coverage does not apply to the sole negligence of the Additional Covered Party. In addition, Coverage shall not apply to liability for the active negligence of the Additional Covered Party in any case where an agreement to indemnify the Additional Covered Party would be invalid under Subdivision (b) of Section 2782 of the Civil Code. Coverage afforded by this endorsement shall be Primary and Noncontributory with respect to any other valid and collectible insurance or risk financing providing coverage to the Additional Covered Party as its principal covered party, including any self-insured retention the Additional Covered Party may have, and where Primary and Noncontributory status is required by contract between the SDRMA Member named above and the Additional Covered Party. Under these terms, any other insurance or risk financing providing coverage to the Additional Covered Party shall be considered excess to this coverage. All other terms and conditions remained unchanged. Coverage provided by this endorsement, under the terms, conditions and exclusions contained in the Liability Coverage Agreement issued by SDRMA to the Member named above shall not be reduced or canceled without 30 days written notice given to the Additional Covered Party via certified mail. The inclusion of more than one Covered Party shall not operate to impair the rights of one Covered Party against another Covered Party and the coverages afforded shall apply as though separate policies have been issued to each Covered Party except that the inclusion of more than one covered party shall not increase the limit of liability of SDRMA. Effective date of this endorsement is: 10/23/2024 SPECIAL DISTRICT RISK MANAGEMENT AUTHORITY Signed by: Brian Kelley, MBA, ARM - Chief Executive Officer California Special Districts Association CSDA Finance Corporation 1112 i Street, Suite 200 1112 I Street, Suite 200 Sacramento, California 95814-2865 Sacramento, California 95814-2865 877-924-CSDA (2732) * Fax 916-442-7889 877-924-CSDA (2732) * Fax 916-442-7889 sdrma.org California Special Districts Alliance partner POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-09-2024 GROUP: POLICY NUMBER: 1424791-2024 CERTIFICATE ID: 11 CERTIFICATE EXPIRES: 09-01-2025 09-01-2024/09-01-2025 CITY OF LA QUINTA SP 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 60 days advance written notice to the employer. We will also give you 60 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2024-09-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF LA QUINTA ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2024 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2024-09-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF LA QUINTA EMPLOYER DESERT HEALTHCARE DISTRICT (A PUBLIC AGENCY) 1140 N INDIAN CANYON DR 2ND FL PALM SPRINGS CA 92262 [P1 P,HO] IREV.7-20141 PRINTED : 09-09-2024 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job: $5,000.00 Sample Rate: 13.30% Regular Premium equals: $ 665.00 Surcharge: 3.00% Additional Waiver charge: $ 19.95 Total premium equals $ 684.95 (665.00 + 19.95)