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Insurance Certificates 2024/25 Coachella Valley Grand Prix Tennis, dba Desert Pickleball LeagueINSURANCE REVIEW W �W FORNIA RE: Coachella Valley Grand Prix Tennis, LLC DBA Desert Pickleball League Certificate of Liability Insurance, Additional Insured & Primary and Noncontributory Pages. 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 01/01/2025 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 ^4c"N"0 CERTIFICATE OF LIABILITY INSURANCE DATEIMYYYI a1/o1/202/2025 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 INSUREDS), 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: Mass Merchandising K&KInsurance Group, Inc. 1712 Magnavox Way Fort Wayne IN 46804 PHONE 1-800-426-2889 FAX 1-260-459-5105 (A/C, No, Ext): (AIC, No): E-MAIL ADDRESS: info@sportsinsurance-kk.com PRODUCER CUSTOMER ID: INSUREII AFFORDING COVERAGE NAIC # INSURED 2001657316 CP# 11904 INSURER A: AIG Specialty Insurance Company 26883 Coachella Valley Grand Prix Tennis LLC INSURER B: 45750 San Luis Rey INSURER C: Palm Desert, CA 92260 INSURER D: A Member of the Sports, Leisure & Entertainment RPG INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2000652276 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 SUUH POLILAFS. LIMI I SHUVVN MAY HAVE BEEN HFDLI(A- l BY PAID LTAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 9YAPG0001334486100 01/05/25 01/05/26 LACHOCCUPRLNCL $1,000,000 CLAIMS-MAUE_UUGUR 12:01 AM 12:01 AM DAMAGE TO RENTED PREMISES Ea Occurrence $1,000,000 MED EXP (Any one person) $5,000 PERSONAL & AUV INJURY $1,000,000 G6N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATC $6,0oo,000 POLICY PROJECT LOC PRODUCTS —COMP/OPAGG $1,000,000 OTHER: PROFESSIONAL LIABILITY $1,000,000 LEGAL LIAB TO PARTICIPANTS $1,000,000 A AUTOMOBILE LIABILITY 9YAP00001334486100 01/05/25 12:01 AM 01/05/26 12:01 AM COMBINED SINGLELIMIT(Ea accident} $1,000,000 BODILY INJURY (Per person) ANY AUTO ONINEO AUTOS SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA OCCUR LIAB EACHOCCURRENCE EXCESS LIAB CLAIMSMADEAGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NIA PER STATUTE OTHER ANY PFiOPRIETl7EilPAIiTNEFif Y / N EXECUTIVE OFFICERIMEMBER E.L. EACH ACCIDENT EXCLUDED? {Mandatory in NH) E.L. DISEASE— EA EMPLOYEE It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE —POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 9YAP00001334486100 2 0 A 12:01 AM 2:0 A 12:01 AM PRIMARY MEDICAL ExcEss MEDICAL $25,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Sports: Pickleball (Ages: 20 & Over), Tennis (Ages: 20 & Over) The certificate holder is added as an additional insured, but only for liability caused, in whale or in part, by the acts or omissions of the named insured. Primary and Noncontributory is added via form PRG 4288. CERTIFICATE HOLDER: CANCELLATION The City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 78-495 Calle Tampico EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH La Quinta, CA 92253 THE POLICY PROVISIONS. Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE %" @ 1988-2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to ITS events and activities " NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9YAPG0001334486100 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Persons Or Organization(s) The City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 Named Insured: Coachella Valley Grand Prix Tennis LLC CP# 11904 I Information required to complete this Schedules if not shown above will be shown in the Declarations. I A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(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 omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional Insured Is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Rcquircd by the contract or agrccmcnt; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whiulluv@I IS loss. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 ©Insurance Services Office, Inc., 2012 Page 2 of 2 ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M. 01/05/25 Forms a part of Policy No. 9YAPG0001334486100 PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE PROVISION - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Person or Organization: The City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 Named Insured: Coachella Valley Grand Prix Tennis LLC CP# 11904 Effective Date: 1/5/25-1/5/26 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 the Person Or Organization shown in the Schedule of this endorsement, provided that: (1) Such Person Or Organization is an additional insured under your policy; (2) The additional insured is a Named Insured under such other insurance; and (3) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of the policy remain the same. Authorized Representative PIRG 4288 12-23 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Declaration of Sole Proprietor DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO �D64Lf7c'�fs YG �I� 9 2 f 1Z,K 1S .1 - 4 C: �-j1 6. 0 9 1 e'1 r -rlR �elf7GI� Individual or Organization Name I declare for the purpose of inducing the City of La Quinta to go forward with any contracts awarded to �n�z 15 t-4�-Ze�irP141'JWlf as`f lode ws: I am the authorized representative of 61I.�9-40 �12is LC- D� r�Pic%1e6&4 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 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 C✓�PTILc —��A PRI— 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 that these declarations shall constitute an addendum to any bid or contracts awarded to J r Date ut ized 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 http://www.dir.ca.gov. 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. Z(iWni LEDGMENT tial) 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 on year. (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. )L (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. -4 (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. (initial) If I 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 Nb day of .�a7/bl�'�du 20 7-5 at California Sign ture of Declarant �� cjC1i4•�-Z Print Name of Declarant Print Name of Company