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HomeMy WebLinkAboutInsurance Certificates 2026/27 LNL Property Services/ AC"R " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 02/09/2026 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 Alisha Grottkau NAME: Insurance Services, LLC PHOTrucordia AICNNo Ext : (888) 208-5599 (ACC, No): Trucordia Ins Svs, LLC DBA: EMAIL Alisha@buildersadvantageins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # PO Box 364 Fair Oaks CA 95628 INSURERA: Atain Specialty Insurance Company 17159 INSURED INSURER B : Scottsdale Insurance Company 41297 LNL Property Services INSURER C : Evanston Ins. Co. 35378 P O BOX 40 INSURER D : INSURER E : Winchester CA 92596 INSURER F : COVERAGES CERTIFICATE NUMBER: CL262974744 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 (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE PREM SESO(Ea occurrence) $ 300,000 _7RETED MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 A Y Y APF200005034 02/28/2026 02/28/2027 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Property damage -single $ 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 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 4,000,000 HCLAIMS-MADE AGGREGATE $ B EXCESS LIAB CXS4076984 02/05/2026 02/28/2027 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 $ C Property 1AA343093 03/23/2025 03/23/2026 BPP $137,812 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured status applies to Certificate holder under the Commercial General Liability Policy subject to attached endorsement. 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. 78-495 Calle Tampico AUTHORIZED REPRESENTATIVE 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 ENDORSEMENT This Endorsement Changes the Policy— Please Read it Carefully PRIMARY AND NON-CONTRIBUTING INSURANCE (Sole Negligence) This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Section IV — Commercial General Liability Conditions, Paragraph 4: Section IV: Commercial General Liability Conditions 4. Other Insurance: d. Specifically and solely for the Third -Party shown below, notwithstanding the provisions of sub -paragraphs a, b, and c of this paragraph, it is hereby agreed that in the event of any "suit" where the damages are caused by the insured's sole negligence, this insurance shall be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non- contributory. The Third -Party to whom this endorsement applies is: Any party for whom the insured is performing services, at a specified project set forth in a written contract, that: (1) has been signed by all parties, including the named insured and the party seeking coverage under this endorsement; and (2) has been entered into before any loss has occurred. Any coverage provided pursuant to this endorsement shall be subject to all other terms, conditions, exclusions and endorsements of the policy to which this form is attached. The endorsement is effective on the inception date of the policy unless otherwise stated below. Policy Number:BWPF0077507R02 Named Insured:Dennis Alva Laffoon Endorsement Effective Date: AF001397 (09116) Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. 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" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. 'Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER:BWPF0077507R02 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization with whom the insured has agreed to waive rights of recovery, provided such agreement is made in writing and prior to the loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, I nc., 2008 Page 1 of 1 11 POLICY NUMBER:BWPF0077507R02 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All projects away from premises owned or rented by you, as required by specific written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I — Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations Schedule above: nor shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, General Aggregate Limit shown in the except damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for General Aggregate Limit. medical expenses under Coverage C regardless of the number of: a. I nsureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 9 Insurance Services Office, Inc., 2008 Page 1 of 2 0 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall Designated Construction Aggregate Limit. not reduce any Project General C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 13 / AC"R " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 04/20/2026 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 Shannon Lee NAME: Insurance Services, LLC PHOTrucordia AICNNo Ext : (888) 208-5599 (ACC, No): Trucordia Ins Svs, LLC DBA: EMAIL Shannon@Buildersadvantageins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # PO Box 364 Fair Oaks CA 95628 INSURERA: California Automobile Insurance Company 38342 INSURED INSURER B : DENNIS LAFFOON INSURER C : PO Box 40 INSURER D : INSURER E : Winchester CA 92596-0040 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2642008377 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 (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS MMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ RETED TO(Ea 4—lo CLAIMS -MADE OCCUR PREM SESDAMAGE occurrrence) $ MED EXP (Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY ElPRO-❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y BA040000099366 03/20/2026 03/20/2027 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r Broadened Coverage $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/ N 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 $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of LA Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta CA 92253-2839 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Business Auto Policy MERCURY To report a claim please call (800) 503-3724 INSURANCE Amended Declarations This declaration supersedes any previous declarations bearing the same number for this policy period. General Information Policy Number: BA040000099366 Policy Period: 03/20/2026 — 03/20/2027 12:01 AM Standard time at the address of the Named Insured Named Insured DENNIS LAFFOON PO BOX 40 WINCHESTER, CA 92596-0040 Business Entity: Individual/Sole Proprietorship Annual Policy Premium: $5,748.76 Agent FALLGATTER RHODES/SCEALES (045197) 1701 G STREET BAKERSFIELD, CA 93301 (661) 324-2424 Date Sent: 04/15/2026 Change Effective: 04/13/2026 Underwriting Company California Automobile Insurance Company P.O. BOX 10730 SANTA ANA, CA 92711-0730 (800) 503-3724 [N1:11a]x0GOIIR BA040000099366 DENNIS LAFFOON Effective Date: 04/13/2026 Schedule of Covered Autos Vehicle #1 2005 GMC SIERRA 2500 HD Garaging Location: 2012 Lagoon Ct Hemet, CA, 92545 VIN: 1GTHK23215F827869 Loss Payee: None Liability $ 4,414 ------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------. Medical Payments $ 68 Uninsured Motorists Bodily Injury $ 719 Comprehensive Actual Cash Value less $1,000 Deductible $ 112 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Collision Actual Cash Value less $1,000 Deductible $ 221 Non -Factory Equipment $0 $ '* Roadside Assistance $100 per occurrence $ 20 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Rental Reimbursement $40 per day/30 days max $ 38 Total Vehicle Premium $ 5,592 * Stated Amount coverage is an agreed to limit on your vehicle's actual cash value, including the actual cash value of any Non -Factory Equipment permanently attached to the vehicle that you disclose to us, and is the most we will pay for a loss. Non -Factory Equipment coverage is subject to a sub -limit shown on the Declarations. Be sure to check the Stated Amount and Non -Factory Equipment sub -limit at every renewal to receive the best value from your Mercury Business Auto policy. It is your responsibility to notify the Company of any requested changes. ** Premium is included with Comprehensive/Collision when coverage is elected. CABADEC 0625 Page 2 of 5 BA040000099366 DENNIS LAFFOON Effective Date: 04/13/2026 Coverage Summary This policy provides only those coverages where a charge is shown in the premium column below. Coverage ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Limit of Insurance Premium Liability $1,000,000 Combined Single Limit $ 4,414 ............................................................................................................................................................................................................................................................................. See Undisclosed Drivers Liability Limits Medical Payments $5,000 per person $ 68 ............................................................................................................................................................................................................................................................................ Uninsured Motorists Bodily Injury $1,000,000 Combined Single Limit $ 719 ............................................................................................................................................................................................................................................................................ Uninsured Motorists Property Damage ............................................................................................................................................................................................................................................................................. Rejected $ Uninsured Motorist Physical Damage/Collision Deductible Waiver ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rejected $ Comprehensive See Schedule of Covered Autos $ 112 ............................................................................................................................................................................................................................................................................. Collision See Schedule of Covered Autos $ 221 ............................................................................................................................................................................................................................................................................. Roadside Assistance See Schedule of Covered Autos $ 20 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rental Reimbursement See Schedule of Covered Autos $ 38 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Broadening Endorsement $ 130 Specified Additional Insured $ 25 California Consumer Services and Fraud Program Fees $ 1.76 Total Policy Premium $ 5,748.76 Driver(s) Name Rated Excluded --------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------------- =--------------------------------------------------------------- DENNIS LAFFOON x LANETTE LAFFOON x Undisclosed Driver Liability Limits Drop Down Limits Full liability limits are for listed drivers on the policy. Additional provisions limiting coverage to state minimum Rejected limits for unlisted drivers may apply. See policy form MCA CABA 08 23 for details. Expanded Driver Full liability limits for non -excluded drivers on the policy. See policy form MCA CABA 08 23 and MCA CAEX 08 23 Selected Full Limits for details. CABADEC 0625 Page 3 of 5 BA040000099366 DENNIS LAFFOON Effective Date: 04/13/2026 Additional Coverages & Provisions Important Notice Warning Minimum Limits: In some cases, the policy affords only minimum limits of liability for bodily injury and property damage as specified by the compulsory or financial responsibility law of the jurisdiction where the loss occurred. Such minimum limits may be less than the stated policy limits. Please review Undisclosed Driver Liability Limits selection to confirm the intended limits for undisclosed drivers is selected. For your protection, California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Premium must be paid in United States dollars, and in a form acceptable to the company. See the Payment Options page on our website for details. CABADEC 0625 Page 4 of 5 BA040000099366 Effective Date: 04/13/2026 DENNIS LAFFOON Specified Additional Insureds CITY OF LA QUINTA 78495 Calle Tampico La Quinta, CA 92253-2839 Discounts Auto Pay -EFT Discount Multi -Line Policy Forms MCA CACC 08 23 - Common Policy Conditions ---------------------------------------------------------------------------------------------------------------------------- MCA CABA 08 23 - Business Auto Coverage Form ---------------------------------------------------------------------------------------------------------------------------- IL N 119 10 15 - California Auto Body Repair Consumer Bill of Rights ---------------------------------------------------------------------------------------------------------------------------- MCA CABE 08 23 - Mercury Broadening Endorsement ------------------------- --------------------------------------------------------- CA 20 48 10 13 - Designated Insured ---------------------------------------------------------------------------------------------------------------------------- MCA CAIN 08 23 - California Individual Named Insured ---------------------------------------------------------------------------------------------------------------------------- MCA20760112 - Exclusion of Named Driver MCA MSUD 06 25 - Undisclosed Drivers Liability Limits Selection Form --------------------------------------------------------------------------------------------------------------------------------------------------------- MCA CAUB 08 23 - California Uninsured Motorists - Bodily Injury MCA CAMP 08 23 - California Auto Medical Payments Coverage ............................................................................................................................................................................................................................................................................. MCA CAEX 08 23 - CA Expanded Driver Coverage - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - MCA RRCV 07 20 - Rental Reimbursement Coverage ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- MCA RSAC 07 20 - Roadside Assistance Coverage Summary of Policy Changes Update Policy Information --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Change(s) Has Resulted in an additional premium of $25.00 $ 5,748.76 CABADEC 0625 Page 5 of 5 72/10/2026 (MM/DD/YYYY) A`oRo° CERTIFICATE OF LIABILITY INSURANCE 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: Certificates Orr & Associates Insurance Services PHONE FAX 28780 Single Oak Dr A/c No EXt: 800-311-3081 A/c No:800-474-3003 Ste 255 E-MAIL certs@orrandassociates.com Temecula CA 92590 License#: OE63493 INSURER A: Nat'l Fire Ins Co of Hartford 20478 INSURED LNLPROP-01 INSURER B : Lnl Property Services 1215 South Buena Vista Str, Suite I INSURERC: San Jacinto CA 92583 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:2138292281 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. INSR LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER EFF MM DDPOLICY/YYYY Y EXP MM/ D/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGERENTED CLAIMS -MADE OCCUR PREMISESS( Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ $ 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 r AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC8035795151 2/6/2026 2/6/2027 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate is subject to policy limits, conditions and exclusions. Evidence of Coverage CERTIFICATE HOLDER 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. Evidence of Coverage AUTHORIZED REPRESENTATIVE � V ��f vA s © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DNA Workers Compensation And Employers Liability Insurance Policy Endorsement IBLANKET WAIVER OF OUR • RECOVER FROMOTHERS This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G-19160-B (11-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 2; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 Policy No: WC 8 35795151 Policy Effective Date: 02/06/2026 Policy Page: 35 of 47 ° Copyright CNA All Rights Reserved.