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Insurance Certificates 2026/27 Animal Samaritans
-----'N ANIMSAM-01 MMOC ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/31 /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 License # 0603247 CONTACT NAME: George Petersen Insurance Agency, Inc. PHONE FAX P.O. Box 3539 (A/C, No, Ext): (707) 525-4150 (A/C, Na):(707) 525-4175 Santa Rosa, CA 95402 ADMDRESS: info@gpins.com INSURED Animal Samaritans Clinic, Inc. 72120 Petland Place Thousand Palms, CA 92276 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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR 01-CP-0063563-01-02 X X 2/1/2026 2/1/2027 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any oneperson) $ 20,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PE0 LOC PRODUCTS - COMP/OP AGG $ 3,000,000 LIQUOR LIABILIT $ 1,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO 01-CP-0063563-01-02 2/1/2026 2/1/2027 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY X AUTOS X PeOacER t AMAGE $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE 01-UB-0063563-02 2/1/2026 2/1/2027 DIED RETENTION $ $ 2,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Directors & Officers VN00000421261 1/13/2026 1/13/2027 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Work performed by the named insured on behalf of the Certificate Holder Certificate holder is named as additional insured with respect to General Liability per CG 20 11 12 19. Waiver of Subrogation applies per NIA-026 11 17. Primary wording applies per NIA-061 B GL 01 25. All forms attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES 0 & 1 0 SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): 2 ) ) ) 2 Additional Premium: $ A. Section II - Who Is An Insured ! 2. ( '( + ) / , ) ! ( ! + + + ) - ! 5 ! H 2 )) + 955 ) ( 15- 2) !( ( * / 9 ) 9 ) - 4 (! (( 5 2+ !+ ( # ! ) - ) ! ) + # 5 2 ( ( 2! )+ ! ) ) _ + + 2 " ( ) ) ( Se�AnIll - LiHs Qf,In+ulapce: ( " + ) 5 + } ! + } + ! 2. + + - - + 1* ! ) 4 #! ( 5 2 )+ + ) + -� ! + ! ) ) ,) + ! )) 2. ! _" )i 53 (i 5 7 ( $ 7 !) / + CG 20 11 12 19 Page 1 of 1 NONPROFITS ° INSURANCE _ ALLIANCE OF CALIFORNIA Part of Nonprofits Insurance Alliance (NIA) NONPROFITS OWN * .. + ) , ) _ ) ) & .. - . $ & ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY - PUBLIC ENTITIES SCHEDULE 3 5 A. SECTION II — WHO IS AN INSURED 4. 5 5 9 a. b. ' »1 5 7 ! 8 6 5 5 3 $ B. SECTION III — LIMITS OF INSURANCE 8 $ 7 8 & ! 5 # C. > Condition 4. Other Insurance SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 4. Other Insurance a. Primary Insurance 7 8 5 C. 5 % < 5 1 5 1 5 ! 5 7 8 ! 5 7 8 ? % $ & 7 8 7 8 b. 5 % $ b. Excess Insurance @ ! 1 7 8 / # ) @ _ ! 9 % A < 7 5 8 # # 5 % 7 8 ' 7 8 5 :g. SECTION I — COV�R@GE A — BODILY INJURY AND PROPERTY DAMAGE. 7 8 ! 5 5 % 7 8 5 7 8 > A B @ 7 8 7 8 9 $ % 5 7 8 > @ 7 8 ' 7 5 8 5 7 B 8 > % Excess Insurance ! % 5 c. Methods of Sharing i # $ 5 4 # % % 5 5 InjNONPROFITSINSURANCE ALLIANCE OF CALIFORNIA Part of Nonprofits Insurance Alliance (NIA) NONPROFITS OWN WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS (WAIVER OF SUBROGATION) + - ) ) + - 2 ) + ) / + SCHEDULE 1 3 4 6 4 5 ! # 5 24L2 ACC)ORLJ /DO �V�CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/16/2026 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 endorsements . PRODUCER AON RISK SERVICES SOUTH INC 3550 LENOX ROAD NORTHEAST SUITE 1700 ATLANTA GA 30326 CONTACT A NAME: on Risk Services, Inc of Florida PHONE No , Ext : 833-506-1544 A/C, No EMAIL ADDRESS: work-comp@trinet.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Indemnity Insurance Company of North America 43575 INSURED TriNet Group, Inc. L/C/F Animal Samaritans Society for the Prevention of Cruelty to Animals, Inc. INSURER B : INSURER C : 1 Park Place, Suite 600 Dublin, CA 94568-7983 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 15956015 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 TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ TED PREM SESOEa oNc.".rce $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ED EOa acc.dentSINGLE LIMIT $ BODILY INJURY Per person $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X WLR C7332712A — 07/01/2025 07/01/2026 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation coverage is limited to worksite employees of Animal Samaritans Society for the Prevention of Cruelty to Animals, Inc. through a co -employment agreement with TriNet HR III, Inc. Waiver of subrogation in favor of CITY OF LA QUINTA as required by written contract. CERTIFICATE HOLDER CANCELLATION CITY OF LA QUINTA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 78495 CALLE TAMPICO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LA QUINTA, CA 92253 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ogon ��k 8etvice9 8outlk Qnc ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured TriNet Group, Inc. L/C/F Animal Samaritans Society for the Prevent Cruelty to Animals, Inc. Endorsement Number 1 Park Place, Suite 600 Policy Number Dublin, CA 945W983 SymboIWLR NumberC7332712A Policy Period Effective Date of Endorsement 07/01/2025TO 07/01/2026 04/16/2026 Issued By (Name of Insurance Company) Indemnity Insurance Company of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (X ) Specific Waiver Name of person or organization: CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 () Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. C= LTA 0PiiRiil' 41, R11i N10114�7111QaII] Authorized Representative WC 90 03 75 (05/18)