Loading...
HomeMy WebLinkAboutInsurance Certificates 2026/27 Paul GorneyINSURANCE REVIEW eca �Cv CALIFORNIA - RE: Paul Gorney DBA Sun Cactus Solutions, LLC, Instructor Agreements for Personal Training and Ananda Meditation Classes. 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 6/22/2026 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: Molestation ($100,000) & Umbrella ($1,000,000) Approved by: List other insurance types such as - molestation, harassment, etc. Oscar Mojica Date: 6/26/2026 DATE (MM/DD/YYYY) A`oRo° CERTIFICATE OF LIABILITY INSURANCE 06/22/2026 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 NAME: Next First Insurance Agency, Inc. PHONE (855) 222-5919 FAX PO Box 60787 A/C No Ext : A/C No): Palo Alto, CA 94306 E-MAIL pP ADDRESS' support@nextinsurance.com INSURED Sun Cactus Solutions 60697 Orourke Cir La Quinta, CA 92253 INSURERA: Next Insurance US Company 116285 1 INSURER C : INSURER E : COVERAGES CERTIFICATE NUMBER:904299366 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 I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00 CLAIMS -MADE xOCCUR DAMAGES( RENTED PREMISES Ea occurrence)$ 1 00,000.00 MED EXP (Any one person) $15,000.00 PERSONAL & ADV INJURY $2,000,000.00 A NXTKHWHK9T-00-GL 06/30/2026 06/30/2027 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT X GENERAL AGGREGATE $4,000,000.00 X X PRODUCTS - COMP/OP AGG $4,000,000.00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR X NXTKHWHK9T-00-GL 06/30/2026 06/30/2027 EACH OCCURRENCE $ 1,000,000.00 AGGREGATE $ 1,000,000.00 A EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Each Occurrence: $2,000,000.00 A Professional Liability NXTKHWHK9T-00-GL 06/30/2026 06/30/2027 Aggregate: $4,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is City of La Quinta. This Certificate Holder is an Additional Insured on the General Liability policy and Umbrella/Excess Liability policy on a primary and non-contributory basis. This Certificate Holder is an Additional Insured on the General Liability policy and Umbrella/Excess Liability policy with respect to ongoing operations. This Certificate Holder is an Additional Insured on the General Liability policy and Umbrella/Excess Liability policy with respect to completed operations. All Additional Insured privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of La Quinta LIVE CERTIFICATE 78495 Calle Tampico La Quints, CA 92253 . {� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN *� 4r_34'. ACCORDANCE WITH THE POLICY PROVISIONS. 1r�,AUTHORIZED Click or scan to view REPRESENTATIVE ^ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy NXTKHWHK9T-00-GL COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II -WHO IS AN INSURED is amended to include the following as insureds: 1. Lessor of Leased Equipment Any person or organization from whom you lease equipment 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 insured only with respect to their 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. No such person or organization is an insured under this section: a. Upon expiration or termination of their contract or agreement with you for such leased equipment ends; b. For any "bodily injury' or "property damage" caused by an 'occurrence" which takes place after expiration or termination of their contractor agreement with you; or c. For any "personal and advertising injury' caused by an 'offense" which takes place after expiration or termination of their contract or agreement with you. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises 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 insured only with respect to liability arising out of your ownership, maintenance or use of that part of the premises leased to you. No such person or organization is an insured under this section for any: a. For "bodily injury' or "property damage" caused by an 'occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of such person ororganization. 3. Grantor of Franchise Any person or organization (referred to below as grantor of a franchise) with whom 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, but only with respect to "bodily injury' or "property damage" arising out of " liability as grantor of a franchise to you 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. NXUS-GL-2037.1-0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 2 permission COMMERCIAL GENERAL LIABILITY C. With respect to the provisions of this endorsement, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. All other terms and conditions of the policy remain unchanged. NXUS-GL-2037.1-0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 2 of 2 permission N4 YOUR QUOTE PROPOSAL DATE CREATED 05/28/2026 INSURED CLASS OF BUSINESS AGENT Sun Cactus Solutions Personal Trainer Peter Reynolds Pacific Global Insurance Brokers DESCRIPTION MONTHLY YEARLY General Liability $43.59 $523.00 Service Fee $0.00 $0.00 Card Transaction Fee $0.00 $0.00 TOTAL DUE AT PURCHASE Pay by bank account or debit card $43.59 $523.00 Pay by credit card $43.59 $523.00 MONTHLY RECURRING PAYMENTS Subsequent monthly payments will begin 20 days after your policy becomes active. Pay by bank account or debit card Pay by credit card $43.59 $43.59 Pricing and coverages prior to purchase will automatically update to reflect NEXT's most current underwriting guidelines. GENERAL LIABLITY EFFECTIVE DATE 06/01/2026 Yearly Premium $523.00 Monthly Premium $43.59 GENERAL LIABILITY COVERAGE LIMITS General Aggregate $4,000,000.00 Per Occurrence $2,000,000.00 Deductible $0.00 Damage to rented premises - Per premise $100,000.00 Medical expenses - Per person $15,000.00 Personal and advertising injury - Per person or organization $2,000,000.00 Products completed - Aggregate $4,000,000.00 UMBRELLA COVERAGE LIMITS Per Occurrence $1,000,000.00 General Aggregate $1,000,000.00 Deductible Not Applicable GENERAL LIABILITY - ADDITIONAL COVERAGES & ENDORSEMENTS Additional Insured - Automatic Status Included Blanket Additional Insured Included Fitness Trainer Professional Liability Included Fitness Trainer Professional Liability - Per Occurrence Limit $2,000,000.00 Fitness Trainer Professional Liability - Aggregate Limit $4,000,000.00 Fitness Trainer Professional Liability - Deductible $0.00 Abuse & Molestation Included Abuse & Molestation - Per Person Limit $100,000.00 Abuse & Molestation - Aggregate Limit $100,000.00 Excess Medical Payments - Participants Included Excess Medical Payments - Participants - Per Person Limit $5,000.00 GENERAL LIABILITY - EXCLUSIONS These risks are not covered under the policy and may require additional endorsements or separate coverage. Important Exclusions: Tanning services General Exclusions: Access or disclosure of confidential or personal information Amusement device such as rides, slides, inflatable games, gymnastics equipment, interactive games and devices Contact with animals Bungee Concert or special events Firearms, fireworks, and other pyrotechnic devices Gymnastics Injury or death to animals Inverted aerial maneuvers Mosh pits Thrown or propelled objects Ring or cage sports Rodeo activities Structure collapse Stunts or special effects Trampolines, not including rebounders that are no more than four feet diameter and no more than two feet above floor level Wall climbing over ten feet Asbestos Certified acts of terrorism Designated products Fungi or bacteria Lead exposure Limitation of coverage to designated premises, projects or operations Acrobatics, acro yoga, or aerial yoga Contact boxing or martial arts Employing other trainers or instructors Exotic dancing Fitness classes involving infants or animals High -heel dancing In -person training of minors under 18 at the insured's private property unless accompanied by a parent or legal guardian Massage therapy Pole dancing, including pole pilates Team sports coaching or coaching player interactions (e.g., basketball, football, tennis, baseball) Nuclear energy liability OFAC sanctions Silica or silica -related dust Swimming pool use, maintenance or construction Pollution Specified sports, leisure, and entertainment activities or devices Subcontracted work Unmanned aircrafts including drones Communicable disease Neurodegenerative injury Employment practices Near SCHEDULE OF POLICY FORMS & ENDORSEMENTS General Liability TITLE FORM NUMBER AND EDITION DATE Policy Jacket NXT-0003 IL 0921 Signature Page NXT-0001 IL 1017 Common Policy Declarations NXUS-GL-0003.2-0322 Calculation Of Premium IL 00 03 09 08 Common Policy Conditions IL 00 17 11 98 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 00 21 09 08 California Changes - Cancellation and Nonrenewal IL 02 70 12 19 California Premium Refund Disclosure Notice IL N 177 09 12 Insured Requested Cancellation NXT-0005 IL 0620 Calculation of Premium NXT-0006 IL 0920 Commercial General Liability Declarations NXUS-GL-0001.1-0619 Commercial General Liability Coverage Form CG 00 01 0413 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And CG 21 06 05 14 Data -Related Liability - With Limited Bodily Injury Exception Exclusion - Unmanned Aircraft CG 21 09 06 15 Exclusion - Designated Products CG 21 3311 85 Limitation Of Coverage To Designated Premises, Project Or Operation Employment -Related Practices Exclusion CG 21 44 04 17 CG 21 47 12 07 Total Pollution Exclusion Endorsement CG 21 49 09 99 Exclusion Of Certified Acts Of Terrorism CG 21 7301 15 Silica Or Silica -Related Dust Exclusion CG 21 96 03 05 Exclusion - Damage To Work Performed By Subcontractors On Your Behalf CG 22 9410 01 Swimming Pool Exclusion NXUS-GL-2031.1-0618 Neurodegenerative Injury Exclusion NXUS-GL-2102.1-0718 Exclusion - Lead NXUS-GL-2017.1-0218 Exclusion -Asbestos NXUS-GL-2018.1-0218 OFAC U.S. Economic and Trade Sanctions Limitations Clause NXUS-GL-2026.1-0218 Abuse and Molestation Coverage NXUS-GL-2036.1-0218 Blanket Additional Insured NXUS-GL-2037.1-0218 Fitness Trainer Professional Liability Coverage NXUS-GL-2040.1-0218 Tanning Limitation NXUS-GL-2041.1-0218 Unintentional Errors and Omission, Knowledge and Notice of Occurrence NXUS-GL-2059.1-0218 Additional Insured - Automatic Status NXUS-GL-2075.1-0619 Exclusions Applicable to Sports/Leisure/Entertainment Activities and Devices NXUS-GL-2088.1-0218 Excess Medical Payments - Participants NXUS-GL-2098.1-0518 Notice of Terrorism Insurance Coverage NXUS-GL-8001.1-0418 Commercial Liability Umbrella Declarations NXUS-UMB-0001.1-0423 Schedule of Forms and Endorsements NXUS-UMB-0002.1-0423 Commercial Liability Umbrella Coverage Form CU 00 01 04 13 Nuclear Energy Liability Exclusion Endorsement (Broad Form) CU 21 23 02 02 Exclusion - Access Or Disclosure Of Confidential Or Personal Material Or CU 21 86 12 20-2020 Information Commercial Umbrella Follow Form Endorsement NXUS-UMB-2000.1-0423 California Changes CU 01 91 05 17 California Changes - Cancellation and Nonrenewal CU 02 23 09 12 Amendment Of Liquor Liability Exclusion CU 21 13 0413 Declaration Regarding 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 ("DfR"). 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. 7A NOWLEDGMENT (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 year. 9—(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) 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(initial) 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. +2g"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. 4=onitial) 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. 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 Workers` Compensation and that I(we) am (are) in compliance. I(we) certify that the forgoing is true and correct. Executed this l day of IVIH 20 a at ' California 7gnture of Declarant Print Name of Declara t Print Name of Company Declaration of Sole Proprietor DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO f-Ar-l-S 56L0 �) uC- Individual or Organization Name I declare fot--th rposee of inducing the City of La Quinta to go forward with any contracts awarded to L 6rwt� as follows: I am the authorized representative of &,o C", S" 1, �,", c , 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 work required for any bid or contract awarded to s'a C�s A,1 L C�a/',J 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 Quinta relating to any bid or contract awarded to �� C � rJ L � d ✓'�cl 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 d clarati 10 4 Date st t,pte an addendum to any bid or contracts awarded to ------- Authorized Re