Insurance Certificates 2025/26 Bill Proctor & AssociatesINSURANCE REVIEW eca Q"&a
CALIFORNIA -
RE: Bill Proctor & Associates - Volunteer Agreement - offering Medicare, medical
insurance presentations, and Information table
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 2/27/2025
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:
[—]$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:
1-1$1,000,000 per occurrence/loss
Other:
Approved by:
List other insurance types such as - molestation, harassment, etc.
Oscar Mojica
Date: 4/16/2025
A� " CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
2/27/2025
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 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: Mellisa Williams
Mel's Insurance Services, Inc.
PHONE FA
760 347-0800 ) (760) 347-0802
AIC, No, E t : (A/C, No
ADDRESS: mel@melsinsurance7.com
81557 Dr Carreon Blvd
INSURER(S) AFFORDING COVERAGE
NAIC #
Ste. B-8
INSURER A: ACE Property and Casualty Insurance Company
20699
Indio CA 92201
INSURED
INSURER B :
INSURER C :
Bill Proctor & Associates Insurance Services, Inc
INSURER D :
57353 Twentynine Palms Highway
INSURER E :
INSURER F :
Yucca Valley CA 92284
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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE F OCCUR
PREMISES (Ea occurrence)
$ 1,000,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
D96729947
12/15/2024
12/15/2025
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑ JE C ❑ LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
(Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
T7MPFRT=MAGE
(Per accident)
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
DED I I RETENTION $
$
ORKERS COMPENSATION
IkND EMPLOYERS' LIABILITY Y / N
EK UIH-
STATUTE I ER
EACH ACCIDENT
$
NY PROPRIETOR/PARTNER/EXECUTIVE ElE.L.
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)
The City of La Quinta, its officers, employees, agents, volunteers, and City Council are named as Additional Insured; primary and non-contributory wording
apply with respect to General Liability when required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of La Quinta
ACCORDANCE WITH THE POLICY PROVISIONS.
78495 Calle Tampico
AUTHORIZED REPRESENTATIVE
M044a ArAaAar Wl;lliArAs
La Quinta CA 92253
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
BUSINESSOWNERS LIABILITY ENHANCEMENTS ENDORSEMENT
Named Insured
Endorsement Number
BILL PROCTOR & ASSOCIATES INSURANCE SERVICES, INC.
BOP47635a0716
Policy Symbol
Policy Number
Policy Period
Effective Date of Endorsement
FNR
D96729947
12-15-2024 to 12-15-2025
12-15-2024
Issued By (Name of Insurance Company)
Pacific Employers
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
TABLE OF CONTENTS
Page
Supplementary Payments — Bail Bonds And Bonds To Appeal Judgments — No Sublimit
2
Medical Expenses — Three Years To Report Expenses
2
Non -Owned Watercraft Under 55 Feet
2
Non -Owned Aircraft
2
Damage To Property — Exception For Equipment Loaned Or Rented To Insured
2
Who Is An Insured — Subsidiaries Or Newly Acquired Or Formed Organizations
3
Who Is An Insured — Employees(Including For CPR and First Aid And Volunteer Workers
3
Additional Insured — Lessor Of Leased Equipment
4
Additional Insured — Managers Or Lessors Of Premises
4
Additional Insured - Vendors
5
Additional Insured — Other Persons Or Organizations Pursuant To Contract Or Agreement
6
Damage To Premises Rented To You — $1,000,000
7
Per Location General Aggregate Limit With Combined Total Aggregate Limit
8
Knowledge/Notice Of Occurrence
9
Bodily Injury, Including Resulting Mental Anguish
9
Coverage Territory, Limited Worldwide
10
Personal Injury, Including Discrimination, Harassment And Segregation
10
Unintentional Failure To Disclose Hazards
10
Other Insurance, Including Primary Provision
10
Waiver Of Subrogation Required By Contract
11
This endorsement modifies the coverages provided under the Businessowners Coverage Form.
Notwithstanding anything to the contrary, the provisions of the Businessowners Coverage Form apply, except as
provided in this endorsement. The titles of the various paragraphs of this endorsement are inserted solely for
convenience or reference and are not to be deemed in any way to limit or affect the provisions to which they
relate.
A. SUPPLEMENTARY PAYMENTS — BAIL BONDS AND BONDS TO APPEAL JUDGMENTS - NO SUBLIMIT
In Section II - Liability, Paragraph A. Coverages, 1. f. Coverage Extension — Supplementary
Payments, subparagraphs (1)(b) and (c) are replaced by the following:
(b) The cost of bail bonds, but only for bond amounts within the available limit of insurance. We do not
have to furnish these bonds.
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(c) The cost of bonds to appeal judgments or release attachments, but only for amounts within the
available limit of insurance. We do not have to furnish these bonds.
B. MEDICAL EXPENSES — THREE YEARS TO REPORT EXPENSES
In Section II — Liability, Paragraph A. Coverages, 2. Medical Expenses, subparagraph a.(b) is
replaced by the following:
(b) The expenses are incurred and reported to us within three years of the date of the accident; and
C. NON -OWNED WATERCRAFT UNDER 55 FEET
In Section II - Liability, Paragraph B. Exclusions, subparagraph (2) of Exclusion 1.g. Aircraft, Auto Or
Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 55 feet long; and
(b) Not being used to carry persons or property for a charge;
D. NON -OWNED AIRCRAFT
In Section II - Liability, Paragraph B. Exclusions, the following exception is added to Exclusion 1.g.
Aircraft, Auto or Watercraft in Section II — Liability:
This exclusion does not apply to an aircraft you do not own provided:
1. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of
the United States of America or Canada, designating that person as a commercial or airline transport
pilot;
2. It is rented with a trained, paid crew; and
3. It does not transport persons or cargo for a charge.
E. DAMAGE TO PROPERTY - EXCEPTION FOR EQUIPMENT LOANED OR RENTED TO THE INSURED
In Section II - Liability, Paragraph B. Exclusions, the following exception is added to Exclusion 1.k.
Damage To Property:
Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to equipment rented or loaned
to the insured, provided such equipment is not being used to perform any operations at a construction job
site.
F. WHO IS AN INSURED -SUBSIDIARIES OR NEWLY ACQUIRED OR FORMED ORGANIZATIONS
In Section II - Liability, Paragraph C. Who is an Insured is amended to include the following:
If there is no other insurance available, each of the following is also a Named Insured:
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1. A subsidiary organization of the first Named Insured shown in the Declarations of which, at the
beginning of the policy period and at the time of loss, the first Named Insured controls, either directly
or indirectly, more than 50 percent of the interests entitled to vote generally in the election of the
governing body of such organization; or
2. A subsidiary organization of the first Named Insured shown in the Declarations that the first Named
Insured acquires or forms during the policy period, if at the time of loss the first Named Insured
controls, either directly or indirectly, more than 50 percent of the interests entitled to vote generally in
the election of the governing body of such organization.
G. WHO IS AN INSURED - EMPLOYEES (INCLUDING CPR AND FIRST AID) AND VOLUNTEER WORKERS
In Section II - Liability, Paragraph C. Who is an Insured, Paragraph 2.a. is replaced by the following:
2. Each of the following is also an insured:
a. Your "employees" but only for acts within the scope of their employment by you or while
performing duties related to the conduct of your business. However, no "employee" is an insured
for:
(1)"Bodily injury" or "personal and advertising injury":
(a) To you, to any of your directors, managers, members, "executive officers" or partners
(whether or not an "employee") or to any co -"employee" while such injured person is
either in the course of his or her employment or while performing duties related to the
conduct of your business;
(b) To the brother, child, parent, sister or spouse of such injured person as a consequence
of any injury described in Paragraph (a) above; or
(c) For which there is any obligation to share damages with or repay someone else who
must pay damages because of any injury described in Paragraph (a) or (b) above.
With respect to "bodily injury" only, the limitations described in Paragraph 2.a.(1) above do
not apply to you or to your directors, managers, members, "executive officers", partners or
supervisors as insureds. The limitations also do not apply to your "employees" as insureds,
with respect to such damages caused by cardiopulmonary resuscitation or first aid services
administered by such an "employee".
(2) "Property damage" to any property owned, occupied or used by you or by any of your
directors, managers, members, "executive officers" or partners (whether or not an
"employee") or by any of your "employees". This limitation does not apply to "property
damage" to premises while rented to you or temporarily occupied by you with the
permission of the owner.
b. Your "volunteer workers", but only while acting within the scope of their activities for you and at
your direction.
H. ADDITIONAL INSUREDS
In Section II - Liability, Paragraph C. Who is an Insured, the following is added:
2. Each of the following is also an insured:
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LESSOR OF LEASED EQUIPMENT
e. Any person or organization from whom you lease equipment, but only with respect to liability for
"bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by
your maintenance, operation or use of equipment leased to you by such person or organization and
only if you are required by a contract or agreement to provide them with such insurance as is
afforded by this policy.
However, the insurance afforded to such additional insured:
(1)Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for
such additional insured.
With respect to the insurance afforded to these additional insureds, this insurance does not apply to
any "occurrence" which takes place after the equipment lease expires.
MANAGERS OR LESSORS OF PREMISES
Any person or organization from whom you lease premises, but only with respect to liability arising
out of the ownership, maintenance or use of that part of the premises leased to you and only if you
are required by a contract or agreement to provide them with such insurance as is afforded by this
policy.
However, the insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for
such additional insured.
With respect to the insurance afforded to these additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
(1) Any "occurrence" that takes place after you cease to be a tenant in such premises.
(2) Structural alterations, new construction or demolition operations performed by or for such
additional insureds.
VENDORS
g. Any person or organization who is a vendor of "your products", but only with respect to "bodily
injury" or "property damage" arising out of "your products" which are distributed or sold in the
regular course of the vendor's business.
However:
(1) The insurance afforded to such vendor only applies to the extent permitted by law; and
(2) If coverage provided to the vendor is required by a contract or agreement, the
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insurance afforded to such vendor will not be broader than that which you are required by the
contract or agreement to provide for such vendor.
With respect to the insurance afforded to these vendors, the following additional exclusions apply:
(1) This insurance afforded the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by
reason of the assumption of liability in a contract or agreement. This exclusion does not
apply to the liability for damages that the vendor would have in the absence of the
contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product made intentionally by the vendor;
(d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration,
testing or the substitution of parts under instructions from the manufacturer, and then
repackaged in the original container;
(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has
agreed to make or normally undertakes to make in the usual course of business, in
connection with the distribution or sale of the products;
(f) Demonstration, installation, servicing or repair operations, except such operations
performed at the vendor's premises in connection with the sale of the product;
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used
as a container, part or ingredient of any other thing or substance by or for the vendor; or
(h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its
own acts or omissions or those of its employees or anyone else acting on its behalf.
However, this exclusion does not apply to:
(i) The exceptions contained in Subparagraph (d) or (f); or
(ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make
or normally undertakes to make in the usual course of business, in connection with
the distribution or sale of the products.
(2) This insurance does not apply to any insured person or organization from whom you have
acquired such products, or any ingredient, part or container entering into, accompanying or
containing such products.
With respect to the insurance afforded to these vendors, the following is added to Paragraph D.
Liability And Medical Expenses Limits Of Insurance:
If coverage provided by the vendor is required by a contract or agreement, the most we will pay on
behalf of the vendor is the amount of insurance:
(1) Required by the contract or agreement; or
(3) Available under the applicable Limits Of Insurance shown in the Declarations;
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whichever is less.
This shall not increase the applicable Limits Of Insurance shown in the Declarations.
OTHER PERSONS OR ORGANIZATIONS PURSUANT TO CONTRACT OR AGREEMENT
h. Any persons or organizations that you are required by a contract or agreement to provide with such
insurance as is afforded by this policy. However, such a person or organization is an insured only:
(1) To the extent such contract or agreement requires the additional insured to be afforded status
as an insured; and
(2) For activities that did not occur, in whole or in part, before the execution of the contract or
agreement.
No person or organization is an insured under this provision:
(1) That is more specifically identified under any other provision of Paragraph C. Who Is An
Insured (regardless of any limitation applicable thereto).
(2) With respect to any assumption of liability in a contract or agreement. This limitation does not
apply to the liability for damages the additional insured would have in the absence of the
contract or agreement.
However, the insurance afforded to such persons or organizations:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide
for such additional insured.
The following is added at the end of Paragraph C. Who Is An Insured:
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named Insured in the Declarations.
However, no person or organization is an insured with respect to the:
a. Ownership, maintenance or use of any assets; or
b. Conduct of any person or organization whose assets, business or organization;
any Named Insured acquires, either directly or indirectly, for any:
(1) "Bodily injury" or "property damage" that occurred; or
(2) "Personal and advertising injury" arising out of an offense first committed;
in whole or in part, before such acquisition is executed.
With respect to the insurance afforded to the persons or organizations described in Paragraphs e., f.,. and
h. above, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance:
The most we will pay on behalf of such person or organization is the amount of insurance:
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(1) Required by the contract or agreement; or
(2) Available under the applicable Limits Of Insurance shown in the Declarations;
whichever is less.
This shall not increase the applicable Limits Of Insurance shown in the Declarations.
I. DAMAGE TO PREMISES RENTED TO YOU — $1,000,000
In Section II - Liability, Paragraph D. Liability and Medical Expenses Limits of Insurance, Paragraphs
3. and 4. are deleted and replaced with the following:
3. Subject to the Liability And Medical Expenses Limits Of Insurance, the most we will pay under
Business Liability Coverage for damages because of "property damage" to any one premises while
rented to you or while temporarily occupied by you with permission of the owner is $1,000,000.
4. Aggregate Limits
The most we will pay for:
a. All "bodily injury" and "property damage" that is included in the "products -completed operations
hazard" is twice the Liability and Medical Expenses limit.
b. Al 1:
(1) "Bodily injury" and "property damage" except damages because of "bodily injury" or "property
damage" included in the "products -completed operations hazard";
(2) Plus medical expenses;
(3) Plus all "personal and advertising injury" caused by offenses committed;
is twice the Liability and Medical Expenses Limit.
The Limits of Insurance of Section II — Liability apply separately to each consecutive annual period
and to any remaining period of less than 12 months, starting with the beginning of the policy period
shown in the Declarations, unless the policy period is extended after issuance for an additional
period of less than 12 months. In that case, the additional period will be deemed part of the last
preceding period for purposes of determining the Limits of Insurance.
J. PER LOCATION GENERAL AGGREGATE LIMIT WITH COMBINED TOTAL AGGREGATE LIMIT
In Section II - Liability, Paragraph D. Liability and Medical Expenses Limits of Insurance, the
following is added:
1. Subject to the Combined Total Aggregate Limit shown in the Declarations, for the sum of all damages
that the insured becomes legally obligated to pay for all "bodily injury" and "property damage" caused
by "occurrences" under Paragraph A.1. Business Liability, and for all medical expenses caused by
accidents under Paragraph A.2. Medical Expenses, which can be attributed only to a single
"location":
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a. A separate Location General Aggregate Limit will apply to each "location", and that limit is equal
to the Other than Products/Completed Operations Aggregate Limit shown in the Declarations.
b. The separate Location General Aggregate Limit is the most we will pay for the sum of all
damages for "bodily injury" or "property damage" under Paragraph A.1. Business Liability,
except in connection with "bodily injury" or "property damage" included in the "products -
completed operations hazard", and for medical expenses under Paragraph A.2. Medical
Expenses, regardless of the number of:
(1) Insureds;
(2) Claims made or "suits" brought; or
(3) Persons or organizations making claims or bringing "suits".
Any payments made under Paragraph A.1. or under Paragraph A.2. Medical Expenses shall
reduce the separate Location General Aggregate Limit for that 'location". Such payments shall
not reduce the Other Than Products/Completed Operations Aggregate Limit shown in the
Declarations nor shall they reduce the separate Location General Aggregate Limit for any
other 'location".
d. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You
and Medical Expense continue to apply. However, instead of being subject to the Other Than
Products/Completed Operations Aggregate Limit shown in the Declarations, such limits will be
subject to the applicable separate Location General Aggregate Limit.
2. Subject to the Combined Total Aggregate Limit shown in the Declarations, for the sum of all damages
that the Insured becomes legally obligated to pay for all "bodily injury" or "property damage" caused
by occurrences under Paragraph A.1. Business Liability and for all medical expenses caused by
accidents under Paragraph A.2., which cannot be attributed only to operations at a single "location".
a. Any payments made under Paragraph A.1. Business Liability for damages or under Paragraph
A.2. for medical expenses shall reduce the amount available under the Other Than
Products/Completed Operations Aggregate Limit or the Products/Completed Operations
Aggregate Limit, whichever is applicable; and
b. Such payments shall not reduce the separate Location General Aggregate Limit applicable to a
single 'location".
3. Subject to the separate Location General Aggregate Limit and all other applicable limits, the
Combined Total Aggregate Limit shown in the Declarations is the most we will pay for the combined
sum of amounts described above, regardless of the number of "locations".
4. Any payments we make for "bodily injury" or "property damage" included in the "products -completed
operations hazard" will reduce the Products -Completed Operations Aggregate Limit regardless of
the number of "locations", and not reduce the Other Than Products/Completed Operations
Aggregate Limit nor the separate Location General Aggregate Limit applicable to a single "location."
5. As used in this endorsement, "location" means premises involving the same or connecting lots, or
premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a
railroad.
6. The provisions of Paragraph D. Liability and Medical Expenses Limits Of Insurance not
otherwise modified by this endorsement shall continue to apply as stipulated.
K. KNOWLEDGE/NOTICE OF OCCURRENCE
In Section II - Liability, Paragraph E. Liability and Medical Expenses General Conditions, 2. Duties
In the Event Of Occurrence, Offense, Claim or Suit is amended to include the following:
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e. Knowledge of an "occurrence" or offense by an agent or "employee" of the insured will not constitute
knowledge by the insured, unless an "executive officer" (whether or not an "employee") of any
insured or an "executive officer's" designee knows about such "occurrence" or offense. Failure of an
agent or "employee" of the insured, other than an "executive officer" (whether or not an "employee")
of any insured or an "executive officer's" designee, to notify us of an "occurrence" or offense that
such person knows about will not affect the insurance afforded to you.
f. If a claim or loss does not reasonably appear to involve this insurance, but it later develops into a
claim or loss to which this insurance applies, the failure to report it to us will not violate this condition,
provided the insured gives us immediate notice as soon as the insured is aware that this insurance
may apply to such loss or claim.
L. BODILY INJURY, INCLUDING RESULTING MENTAL ANGUISH
In Section II - Liability, Paragraph F. Liability and Medical Expenses Definitions, paragraph 3. is
deleted and replaced with the following:
3. "Bodily injury" means physical:
a. Injury;
b. Sickness; or
c. Disease;
sustained by a person, including resulting death, humiliation, mental anguish, mental injury or shock
at any time. All such loss shall be deemed to occur at the time of the physical injury, sickness or
disease.
M. COVERAGE TERRITORY, LIMITED WORLDWIDE
In Section II - Liability, Paragraph F. Liability and Medical Expenses Definitions, paragraph 4. is
deleted and replaced by the following:
4. "Coverage territory" means all parts of the world.
However, "coverage territory" does not include any:
a. "Bodily injury" or "property damage" that takes place or any offense committed outside of the
United States of America (including its possessions and territories), Canada and Puerto Rico,
unless the insured's responsibility to pay damages is determined by a "suit" on the merits that is
brought in the United States of America (including its possessions and territories), Canada or
Puerto Rico; or
b. Injury or damage in connection with any "suit" brought outside the United States of America
(including its possessions and territories), Canada and Puerto Rico.
N. PERSONAL INJURY, INCLUDING DISCRIMINATION, HARASSMENT AND SEGREGATION
In Section II - Liability, Paragraph F. Liability and Medical Expenses Definitions, paragraph 14. is
amended to include the following:
h. Discrimination, harassment or segregation based on a person's age, color, national origin, race,
religion or sex unless committed by or at the direction of any "executive officer", director, stockholder,
partner or member of the insured.
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O. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
In Section III — Common Policy Conditions, Paragraph C. Concealment, Misrepresentation or Fraud
is amended to include the following additional paragraph:
Unintentional failure of an "employee" of the insured to disclose a hazard or other material information will
not violate this condition, unless an "executive officer" (whether or not an "employee") of any insured
knows about such hazard or other material information.
P. OTHER INSURANCE, INCLUDING PRIMARY PROVISION
In Section III — Common Policy Conditions, Paragraph H. Other Insurance, subparagraphs 2. and 3.
are replaced by the following:
H. Other Insurance
If other valid and collectible insurance is available to the insured for a loss we cover under this insurance,
our obligations are limited as follows:
1. Primary Insurance
This insurance is primary except when Paragraph 2 below applies. If this insurance is primary, our
obligations are not affected unless any of the other insurance is also primary. Then, we will share with
all that other insurance by the method described in Paragraph 3 below.
2. Excess Insurance
a. This insurance is excess over:
(1) Any of the other insurance, whether primary, excess, contingent or on any other basis:
(a)That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for
"your work";
(b)That is insurance that applies to "property damage" to premises rented to you or
temporarily occupied by you with permission of the owner; or
(c) If the loss arises out of aircraft, "autos" or watercraft to the extent not subject to Exclusion
g. of Section II.B. Exclusions, 1. Applicable to Business Liability Coverage; or
(2) Any other primary insurance available to you covering liability for damages arising out of the
premises or operations for which you have been added as an additional insured.
b. When this insurance is excess, we will have no duty to defend the insured against any "suit" if any
other insurer has a duty to defend the insured against that "suit." If no other insurer defends, we
will undertake to do so, but we will be entitled to the insured's rights against all those other
insurers.
c. When this insurance is excess over other insurance, we will pay only our share of the amount of
the loss, if any, that exceeds the sum of:
(1) The total amount that all such other insurance would pay for the loss in the absence of this
insurance;
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(2) The total of all deductible and self -insured amounts under all that other insurance.
d. We will share the remaining loss, if any, with any other insurance that is not described in this
Excess Insurance provision and was not brought specifically to apply in excess of the Limits of
Insurance shown in the Declarations of this Coverage Part.
3. Method of Sharing
If all of the other insurance permits contribution by equal shares, we will follow this method also.
Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of
insurance or none of the loss remains, whichever comes first.
If any of the other insurance does not permit contribution by equal shares, we will contribute by limits.
Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the
total applicable limits of insurance of all insurers.
Q. WAIVER OF SUBROGATION REQUIRED BY CONTRACT
In Section III — Common Policy Conditions, Paragraph K. Transfer of Rights of Recovery Against
Others To Us, subparagraph 2. is replaced by the following:
2. Applicable to Businessowners Liability Coverage:
We will waive the rights of recovery we would otherwise have had against another person or organization,
for loss to which this insurance applies, provided the insured has waived their rights of recovery against
such person or organization in a contract or agreement that is executed before such loss.
To the extent that the insured's rights to recover all or part of any payment made under this Coverage
Part have not been waived, those rights are transferred to us. The insured must do nothing after loss to
impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce
them. This paragraph does not apply to Medical Expenses Coverage.
All other terms and conditions of the policy remain unchanged.
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Declaration ReRardinR 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.
ACKNOWLEDGMENT
- (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 war.
(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 top 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.
_A((iinitial) 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.
I((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.
_Ipnitial) 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.
Doc ID:db0a682ad8d54830deace5a887a3b45d88169a54
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 02 / 25 / 202d5ay of 20_ at , California
lr,rn �rot1 cr
Signature of Declarant
Jeremy Proctor President
Print Name of Declarant
Bill Proctor& Associates Insurence Services
Print Name of Company
Doc ID:db0a682ad8d54830deace5a887a3b45d88169a54
Declaration of Sole Proprietor
DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO
Bill Proctor & Associates Insurance Services, Inc
Individual or Organization Name
I declare for the purpose of inducing the City of La Quinta to go forward with any contracts
awarded to Bill Proctor & Associates Insurance Services, Inc as follows:
I am the authorized representative of Bill Proctor & Associates Insurance Services, Inc
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
Bill Proctor & Associates Insurance Services, Inc . 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
Bill Proctor & Associates Insurance Services, Inc
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
Bill Proctor & Associates Insurance Services, Inc
04/16/2025
Date Au orized Representative