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Insurance Certificates 2025/26 Senior Advocates of the DesertRE: INSURANCE REVIEW 401414 -(,1 I1 R\I\- Senior Advocates of the Desert: Certificate of Insurance-GL, Additional Insured Endorsement,Primary non contributory, and Workers Compensation/Waiver of Subrogation insurance for Volunteer Organization 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 7/9/2025 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: $1,000,000 per occurrence/loss Other: Approved by: Date: List other insurance types such as - molestation, harassment, etc. 78495 Calle Tampico 112 0uinla, California 92253 1160 177 7000 1 www.laquintaca.gov ACORO SENIADV-01 HAYLYBARRETT CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/9/2025 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 NFP Property & Casualty Services, Inc. 400 S Farrell Drive Suite B-170 Palm Springs, CA 92262 INSURED Senior Advocates of the Desert PO Box 2827 Cathedral City, CA 92235 CONTACT Evelyn Jackson NAME: PHONE 714 577-4535 ADDRESS: evelyn.jackson@nfp.com (A'4Xc, No): (714) 975-8966 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Nonprofts' Insurance Alliance of California Inc. XXXXXX INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : 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 POLIC ES 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 INSD SUBR W VD POLICY NUMBER /YPOLICY EFF (MM/DDYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 2024-38222 12/10/2024 12/10/2025 DAMAGE TO RENTED PREMISES (Ea occurrence) 500,000 $ MED EXP (Any one person) $ 20,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PE0 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ ANY AUTO 2024-38222 12/10/2024 12/10/2025 BODILY INJURY (Per person) $ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ X AUTOS ONLY X NON-OWNED ONLYY (Per accidentDAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (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 A Directors & Officers 2024-38222-DO-NPO LIQUOR LIABILITY 2024-38222 1 12/10/2024 12/10/2025 Each occurrence/ Agg 12/10/2024 12/10/2025 EACH COMMON /Aggrega 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta is named Additional insured as respects to General Liability so long as a written contract or agreement to such exists with the named insured prior to a loss as per attached endorsement CG 20 26 12 19. General Liability Coverage is Primary and Non -Contributory per endorsement NIAC-E61 02/19 attached. CERTIFICATE HOLDER CANCELLATION Cityof La Quinta 78495 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 POLICY NUMBER: 2024-38222 COMMERCIAL GENERAL LIABILITY Named Insured: Senior Advocates of the Desert CG 20 26 12 19 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): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2024-38222 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: A. Section II — WHO IS AN INSURED is amended to include: 4. Any public entity as an additional insured, and the officers, officials, employees, agents and/or volunteers of that public entity, as applicable, who may be named in the Schedule above, when you have agreed in a written contract or written agreement presently in effect or becoming effective during the term of this policy, that such public entity and/or its officers, officials, employees, agents and/or volunteers be added as an additional insured(s) on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your negligent acts or omissions; or b. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity or individual is an additional insured for liability arising out of the sole negligence by that public entity or its designated individuals. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. B. Section III — LIMITS OF INSURANCE is amended to include: 8. The limits of insurance applicable to the public entity and applicable individuals identified as an additional insured(s) pursuant to Provision A.4. above, are those specified in the written contract between you and that public entity, or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. C. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in a written contract or written agreement: (1) That this insurance be primary. If other insurance is also primary, we will share with all that other insurance as described in c. below; or NIAC-E61 02 19 Page 1 of 2 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. POLICY NUMBER: 2024-38222 (2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below. b. Excess Insurance 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 fire, lightning, or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A— BODILY INJURY AND PROPERTY DAMAGE. (e) Any other insurance available to an additional insured(s) under this Endorsement covering liability for damages which are subject to this endorsement and for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured(s) against any "suit" if any other insurer has a duty to defend the additional insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) 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: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self -insured amounts under all that other insurance. (3) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other insurance available to the additional insured(s) 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 other the other insurance available to the additional insured(s) 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. NIAC-E61 02 19 Page 2 of 2 THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270 Policy Information: Policy Number: 76 WEG DS6741 July 16, 2025 Contact Us Visit https://business.theharttord.com 24/7 access to pay bills. view policy documents, get your certificate of insurance and more. Need Help? Chat online or call us at (866) 467 8730. We're here Monday - Friday. You can find information about your policy enclosed. You can also find this info online at https:/ihusiness.thehartford.corn. If you have any questions or concerns about what you see, contact us at any of the options listed on this page. Thanks for choosing us for your business insurance needs Sincerely, The Hartford WLTROO 1 — ,,1( er )N$) �- CERTIFICATE OF LIABILITY INSURANCE DATE(MMrODKVYV) 07/16/2025 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 be endorsed. If SUBROGATIONIS WANED, subject to the terms and conditions al the policy, certain policies may requue an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER PAYCHEX INSURANCE AGENCY INC 76210705 225 KENNETH DR STE 110 ROCHESTER NY 14623 CONTACT NAME PI:ONF (877) 266-6850 (Arc, "O � FAX (5851 3.59-1894 {Arc, NoY. E-MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAICP INSURER A Hartford Casualty Insurance Company 25424 INSURED SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270-1818 INSURER B . eISURBRC: INSURER 0 WSURER E: INSURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LSTED 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 NAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE Of INSURANCE ADOL MAR SORB WVL) POLICY NUMBER POLICY EFT ikeIYORterrY1-.-. POLICY EXP fMMIDDIY YYY) LIMITS OOM M ERC AL GENERAL LIABK iY EACH OCCURRENCE 1 CLAIM -MADE jOCCUR DAMAGE TO REV T D FREMIBES fEa occu-rencel MED EXP (Any ore person) PERSONAL 8 ADV INJURY GEN'L ,�JII AGGREGATE LIMIT APPLIES PRO- JEC T PER. ❑ I Oc GENERAI. AGC.R EGA' TEE IPOL:CY ❑ PRODUCTS - COMPIvOP AGO OTHER' AUTOMOBILE _ — LIABIUTY ANY AUTO ALL CANNED AUTOS HIRED AUTOS SCHEDUtEr:, AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT , Ea xotederttl 9OOILY INJURY iPer person) BODILY INJURY (Ps, accident) — PROPERTY DAMA.vE (ter ae 1dent) _ UMBRELLA UAB EXCESS LAB OCCUR CLAIMS MAUL EACH OCCURRENCE An(WFlLITF CFnl IRETENT.CN $ — A WORKERS COMPENSATION AND EMPLOYERS' LIABIUrf ANY YIN PROPRIETOR/PARTNER/EXECUTIVE ^— CFFICER.(MEMbER EXCLUDED? — (Mandatory In NH) It S'es. describe Loper DESCRIPTION OF OPERATIONS 'Mire NIA X 76 WEG DS6741 06.25,2025 06/25/2028 X PER C'H- STATUTE Fit E L EACH ACCIDENT $1,000,000 E L DISEASE -EA EMPLOYEE 51,000,000 E L DISEASE - FOJCY L1411T S1,000,000 OFSCR)PT)ON OF OPERATION. ILOCA7IONS / VEHICLES IACORD 101, Addlbonar Remarae Schedule, may be attached II more space to required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation, applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306 attached to this policy_ CERTIFICAjJHOLDER City of La Qulnta 78-495 CA LLE TA M PICO LA QUINTA CA 92253-2839 CANCELLATION 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 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2018103) The ACORD name and logo arc registered marks of ACORD THE HARTFORD THE HARTFORD BUSINESS SERVICE CENTER 3600 WSEMAN BLVD SAN ANTONIO TX 78251 SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270 Policy Information: Policy Number: 76 WEG DS6741 July 16. 2025 Contact Us Visit httos:/ business.thehartford,corri 2417 access to pay bills, view policy documents, get your certificate of insurance and more. Need Help? Chat online or call us at (877) 287- 1312. We're here Monday - Friday. INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes, Please contact us. Thank you for allowing us to service your business needs. Sincerely. Your Hartford Service Team SCPHS015 THE HARTFORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGE IN INFORMATION PAGE INSURER: Hartford Casualty Insurance Company NCCI Company Number: 14397 Policy Number: 76 WEG DS6741 Effective Date: 07/16/25 Named Insured and Address: FEIN Number: 45-4219977 Endorsement Number: 001 Effective hour is the same as stated on the Information Page of the policy. SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270 It is agreed that the policy is amended as follows: This is NOT a bill. However, any changes in your premium will be reflected in your next billing statement. You will receive a separate bill from The Hartford. In consideration of an additional premium of S184, it is agreed that: Policy is amended to add the following condition(s): Waiver of Our Right to Recover from Others Endorsement Policy is amended to add the following Endorsement Forms reflecting the changes made to your policy. WC990006B(.2) WC040306 WC990006B(.1 P) Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy G-4119-0 Countersigned by st,, 03 Cldv�.t�r�trfr1 Authorized Representative Form WC 99 00 06 B (1) Printed in U.S.A. Page 1 Process Date: 07/16/25 Policy Expiration Date: 06/25/26 CHANGE IN INFORMATION PAGE (Continued) Policy Number: 76 WEG DS6741 SCHEDULE IT IS AGREED THAT THE POLICY IS AMENDED AS FOLLOWS' CLASS CODE NUMBER AND DESCRIPTION CA - Location 1 Rating Period* 06/25/2025-07/16/2025 8742 SALESPERSONS - OUTSIDE Rating Period: 06/25/2025-06/25/2026 8742 SALESPERSONS - OUTSIDE Rating Period: 07/16/2025-06/25/2026 ESTIMATED RATES PER 100 ESTIMATED TOTAL ANNUAL OF ANNUAL REMUNERATION REMUNERATION PREMIUMS 4.637.00 80.600.00 0.630000 29 0.630000 -508 8742 75.963.00 0.630000 479 SALESPERSONS - OUTSIDE Total State Summary Total Class Premium CA Territorial Differential Waiver charge Small Policy Credit Expense constant Terrorism Risk Insurance Program Reau CA User Fund CA Fraud CA Uninsured Employers Benefit Trust CA Subsequent Injuries Benefit Trust CA Occupational Safety & Health Fund CA Labor Enforcement & Compliance Fun California Total Cost 0.00 1.156000 1 0.00 0.020000 236 0.00 25 -60 0.00 0.00 0.020000 0 0.00 1.237000 2 0.00 0.409600 0 0.00 0.081800 0 0.00 3.014800 5 0.00 0.188500 0 0.00 0.105800 0 0 0 184 Form WC 99 00 06 B (1) Printed in U.S.A. Page 2 Process Date: 07; 16/25 Policy Expiration Date: 06/25/26 THE HARTFORD POLICY HOLDER NOTICE - PAYROLL BILLING Thank you for choosing The Hartford. Your policy is on our payroll billing method. The payroll billing method uses actual payrolls received throughout the policy period and a blended rate(s) to determine premiums due during the policy period. To leam more about how your premium is calculated on the payroll billing method please visit nttos;//www,thellartford.cor lended Below are the blended rate(s) being used for each state and classification code on your policy: State Class Code Blended Rate Effective 1: 34300 DENISE WAY, RANCHO MIRAGE, CA 8742 0.580000 06/25/2025 1: 34300 DENISE WAY, RANCHO MIRAGE, CA 8742 0.850000 07/16/2025 Form G-4119-0 Pnnted in U.S.A. © 2017, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG DS6741 Endorsement Number: 001 Effective Date: 07/16/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270 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 2 % of the California workers' compensation premium otherwise due on such remuneration SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from LIS Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A Process Date: 07/16/25 Policy Expiration Date: 06/25/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 VVEG DS6741 Endorsement Number: 001 Effective Date: 07/16/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: SENIOR ADVOCATES OF THE DESERT 34300 DENISE WAY RANCHO MIRAGE CA 92270 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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of La Quinta, 78-495 Calle Tampico. La Quinta CA 92253 Countersigned by Authorized Representative Form WC 04 03 06 (1) Punted in U.S.A. Process Date: 07/16/25 Policy Expiration Date: 06/25.26