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Insurance Certificates 2025/26 Palm Springs Party Co LLCINSURANCE REVIEW W okra CALIFORNIA - RE: Palm Springs Party Company LLC Insurance for Tree Lighting Ceremony 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 08/07/2025 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: List other insurance types such as - molestation, harassment, etc. Oscar Mojica Date: 9/9/2025 AFRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 08/07/2025 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 Laurie Baldwin NAME: AssuredPartners of Arizona, LLC AICNNo Ext: (800) 328-6770 FAX No): (800) 328-6770 14614 North Kierland Boulevard, Suite #150 E-MAIL Laurie.Baldwin@assuredpartners.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Scottsdale AZ 85254 INSURERA: W.R. Berkley Corporation 31295 INSURED INSURER B : Great American Insurance Company 16691 Palm Springs Party Company, LLC INSURER C : INSURER D : 81074 Jessica Way INSURER E : Indio CA 92201 INSURER F : COVERAGES CERTIFICATE NUMBER: 24-25 Master Certificate 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 CONTRACTOR 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 INSD WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE PREM SESO(Ea occurrence) $ 100,000 _7RETED MED EXP (Any one person) $ Excluded PERSONAL& ADV INJURY $ 1,000,000 A Y CGL017982322 12/07/2024 12/07/2025 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN D? OFFICER/MEMBER EXCLUDE / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Excess Accident B BSR-E883624-02 12/07/2024 12/07/2025 Limit of Claim 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of La Quinta, its officers, officials, employees and agents are an additional insureds on the general liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of La Quinta, its officers, ACCORDANCE WITH THE POLICY PROVISIONS. officials, employees and agents AUTHORIZED REPRESENTATIVE 78495 Calle Tampico 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 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - YOUR AMUSEMENT OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Additional Insured Person(s) or Organization(s): Any party for whom you are providing ongoing operations, and the owner of the premises where the ongoing operations are being performed. 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 to the extent that the liability for "bodily injury", "property damage" or "personal and advertising injury" is caused solely by your negligent acts, errors or omissions in the performance of ongoing operations for the additional insured shown in the Schedule. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" to any employee of you or to any obligation of the additional insured to indemnify another because of damages arising out of such injury. 2. 'Bodily injury", "property damage" or "personal and advertising injury" for which the Named Insured is afforded no coverage under this policy of insurance. C. With respect to the insurance afforded to these additional insureds, SECTION III — LIMITS OF INSURANCE is amended to include the following: The limits applicable to the additional insured are those specified in any agreement or in the Declarations of this Coverage Part, whichever is less. If no limits are specified in the agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of insurance are inclusive of and not in additional to the limits of insurance shown in the Declarations. D. With respect to the insurance afforded to these additional insureds, paragraph 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following: Any coverage provided herein will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless you have agreed that this insurance will be primary. This insurance will be noncontributory only if you have so agreed and this coverage is determined to be primary. All other terms and conditions of this policy remain unchanged. BR5085G (11,119) Includes copyrighted material of Insurance Services Office, Inc , with its permission. ,4coizo' CERTIFICATE OF LIABILITY INSURANCE ��_ DATE (MM/DD/YYYY) 08/29/2025 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: Julie Contreras A//CNN Ext: (760)775-7256 (AC No; (760)775-7222 Palm Valley Insurance 45541 Oasis St Indio, CA 92201 E-MAIL ADDRESS: julie@palmvalleyinsurance.com y INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: infinity Select Insurance Company 20260K INSURED INSURER B : INSURERC: Palm Springs Party Company INSURER D : 81074 Jessica Way Indio, CA92201-3709 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 00088151-250829124748 REVISION NUMBER: 1 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 CONTRACTOR 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 OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER EFF MM/ DPOLICY/YYYY Y EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1:1 OCCUR EACH OCCURRENCE $ DAMAGE TO PREMISESEa occu ence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 50008160901 05/03/2025 05/03/2026 Ea accc den SINGLE LIMIT $ 1 000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta, CA 92253 I I 6ffwvw� JCC © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are re tered marks of ACORD Printed by JCC on 08/29/2025 at 12:49PM Declaration of Sole Proprietor DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO Individual or Organization Name I declare for the purpose of inducing the awarded to �4�w S � r; �S5 Cat f I wn the authorized representative of City of La 0-I) V%^ PC% A %01 Quints to go forward with any contracts L L e as follows: 4; ^#1 te L C an independent contractor for the purposes of the CaliforniaWoricers' Compensationand Labor laws. This organization will hire no employees other than theParents, spouses, or children of its board members for work required for any bid or contract awarded to e(^ S� r I A �� � �--, Cn V1�IA .� C. � � .All worked required will be perfonmed personally and solely by me r other board members of the organization their parents, spouses or children, or persons who perform voluntary service without pay to the organization. 16 If, however, the organization shall ever hire employees to performthis contract or any portion thereof, the organization shall obtain Workers' Compensation Insurance and provide proof of Workers' Compensation Insurance coverage to the City of LaI uints. If the organization shall ever hire a subcontractor to perform this contract or any portion thereof, and the subcontractor go has employees, then the organization shall require its subcontractor to obtain Workers' Compensationsurance Coverage, or the orgamzation shall obtain Workers' Compensation Coverage for that subcontractor's employees. This document constitutes a dec,laration Y the organization against its financial interest, relative to any claims it should assert under the California Workers' Compensation and/or Labor laws agal s of La Quints relating to any bid or contract awarded to �lw, S-Or, A�i Pa���l �v�,0aw,� �-L C The orgazation will defendindemnify and hold harmless ity the CofLa Quinints from any and all claims and liability, including Workers' Compensation claims and liability that may be asserted ores is e y 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 Quints for all damages the City o a Quints thereby suffers. I agree that these declarations shall constitute an addendum to any bold or contracts awarded to COAtw, i �v�e^� L L C doom 000. 002 Date Authorized Representative Declaration RVaardinpCalifornia Workers' Compensation You are required to complete tkicbecausehPrAHP you have not filed a certificate regarding aw requires all compensation i compensation i nsurance with City cf La Quints. California I if they have only one employee. If you ao not know whether you are nsuranceeven , requires to carry workers' compensation Industrial Relations ( "DIR "). Information 40 insurance, is also avail workers' employers to carry workers' find out by contacting the California Department of able on the DIR's website at htt0 www.dir.ca.�ov. You should also consult with your attorney,insurance agent or broker, or carrier regarding the specificsof your situation and your options. If you are subject to the WorkersCompensation Laws of California you must promptly file a certificate of Workers' Compensation Insurance with City of La Quints. If you have a certificate of self-insurance from the DIR, you must file that certificate with City of La Quints. When completing this formremember 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 workerscompensation 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. ,(2.(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) acknowledge that if evidence is found that contradicts this declaration, City of La Quints 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 workerscompensation insurance coverage for any employees of my business. I hereby warrant that this business is exempt from the California Labor Code provisions regarding workerscompensation insurance because it has no employees. (initial) I agree to hold City of La Quints 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 futureI will immediately notify City of La Quints and provide a certified WorkersCompensation certificate to the City. � {( _ _ . i' r � � • �? j� `.•. r �� � ♦ � r Q �� '"'��./�.i`i[��, T• � • . � � � � _ � � r �'� : � `� ' �j� �� ..1 t'i •. 4 y ��, ; ,'1. � � , _ ` `j '♦ -. `. � f •, � !� � � � � � � � � �. � t i � t 1. ' � _\ � � '� � J t � ' ` 1 � �. /w� ��� �� t 11 ♦• �iL/.�L�►'.► •_`�' •�J r' -� �d� _ .V+�L.� �S IL .� .i i� 1. ��. �•� ' �.. �. !._.. t . ! •� �� i! , CERTIFICATION (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 WorkersCompensation and that I(we) am (are) ion compliance. I(we) certify that the forgoing is true and correct. Executed this day of 20 2at Z- ,California Signature of Declarant co( Print Name of Declarant Print Name of Company r-'11161�✓v ^f%G^_`' CMG