Loading...
Insurance Certificates 2017/18 CVRMAC ORDS CERTIFICATEDATE OF LIABILITY INSURANCE (MMIDDIYYYY) 1/9/2U1H 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 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 Desert Cornerstone Insurance Service, Inc. CA License #0F15709 81713 Highway 111, Ste E Indio CA 92201 CONTACT Sanaa Martin NAME: PHO_ No Eat': (760) 347-7723 FAX Nn]: (760)347-7725 �'nnAIL sanae@desertcornerstoneins.com ADDREss: INSURERIS) AFFORDING COVERAGE NAIC• INSURER A ;Technology Insurance Co. 42376 INSURED Coachella Valley Rescue Mission DBA: CVRM, , New Life Resale Boutique P.O.Box 10660 Indio CA 92202-2564 INSURER a:Wesco Insurance Co. 25011 INSURER C :security National. InS Co 19879 INSURERD: A INSURER E: 1 CLAIMS -MADE X OCCUR INSURER p COVERAGES CERTIFICATE NU MBER:2017GLALEXPLDO REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS iP LTR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE OF INSURANCE PERTAIN, POLICIES. I OL pYYp LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER ISSUED TO CONTRACT THE POLICIES REDUCED BY POUCYEFF) (MMrDOlYYYY THE INSURED OR OTHER DESCRIBED PAID CLAIMS. POLICY (MMIODNYYYj NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS X COMMERCIAL GENERAL LIABILITY ,JNSD EACH OCCURRENCE $ 1,000,000 A 1 CLAIMS -MADE X OCCUR DAMAGE 111 REN17-n REMISES (Ea occurrence) $ 100,000 X TPP1064878 00 2/13/2017 2/13/2018 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3, 000,000 POLICY IC JECT- LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER- Professional Liability $ 3,000,000 A AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIM1T (Ea accident) BODILY INJURY (Per person) $ ], ,000,000 $ ALL OWNED AUTOS SCHEDULED AUTOS TPP1064878 00 2/13/2017 2/13/2010 BODILY INJURY (Per accident) $ X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 3,000,000 DEC) RETENT ON$ WOM..525553 2/13/2017 2/1.3/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER I OTH- STATUTE ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE N / A L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) E.L DISEASE - EA EMPLOYEE $ If yes. describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ C A Directors & Officers Liab Professional Liability SMT. 1525437 01 TPP1064078 00 2/13/2017 2/13/2017 2/13/2018 2/13/2018 Limit: 5,000,000 Limit: 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is regu( ed) Re: 2018 Grant - City of La Quinta & La Quinta Housing Authority is added as Additional Insured as respects General Liability per attached. CERTIFICATE HOLDER CANCELLATION City of La Quinta & La Quinta Housing Authority 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 Matt List/SAN Mditiar Ili ACORD 25 (2014/01) INS026 (201401) CO 1988-2014 ACORD CORPORATION All rights reserved_ The ACORD name and logo are registered marks of ACORD POLICY NUMBER; TPP1064878 00 COMMERCIAL GENERAL LIABILITY 33-0729 10-13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY COVERAGE EXPANSION ENDORSEMENT (NON -CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART — CG 00 01 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Additional Premium $200 SECTION I — COVERAGES COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Exclusions 9. i. Aircraft, Auto Or Watercraft Paragraph (2) is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet Tong; and (b) Not being used to carry persons or property for a charge. This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. Damage To Property Paragraph (2) is not applicable. (2) This paragraph is deleted. Paragraph (4) replaced with the following. (4) Personal property in the care, custody or control of the insured which exceeds $50,000 regardless of the number of: (a) Insureds (b) Claims made; or (c) Persons or organizations making claims The most we will pay under this coverage is $50,000. Our duty to pay and defend ends under this coverage when the coverage limit has been exhausted. n. Recall Of Products, Work Or Impaired Property Replace with the following: Damages claimed for any Toss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) "Your product"; 33-0729 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 6 Used with permission COVERAGE C — MEDICAL PAYMENTS Paragraph 1.a. (3)(b) under SECTION I — COVERAGE C — MEDICAL PAYMENTS is replaced with the following: (b) The expenses are incurred and reported to us within two years of the date of the accident; However, expenses reported to us after two years of the date of the accident will not be denied solely because of the late submission unless such late submission operates to prejudice our rights; and SUPPLEMENTARY PAYMENTS — COVERAGES A AND B Paragraph 1.b. and 1.d. under SECTION I - SUPPLEMENTARY PAYMENTS — COVERAGE A AND B is replaced with the following: b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual Toss of earnings up to $300 a day because of time off from work. ***** SECTION Ii— WHO IS AN INSURED Paragraph 3.a. is amended as follows: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, provision a. above does not apply if the newly formed or acquired organization is excluded by either a provision of the Coverage Form or by endorsement. The following is added under SECTION II — WHO IS AN INSURED:: 4. Organization over which you maintain ownership of more than 50°/c will be a Named Insured if there is no other similar insurance available to that organization; however a. COVERAGE A. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and b. COVERAGE B. does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. If such organizations are not shown in the DECLARATIONS, you must report them to us within 130 days of inception date of the policy. 5. Any person or organization with whom you agreed, because of written contract or written agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendors business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspection, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; 33-0729 10 13 includes copyrighted material of Insurance Services Office, Inc., Page 3 of 6 Used with permission SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit Replace paragraph 2.a. with the following: a. You must see to it we are notified as soon as practicable of an "occurrence" or an offense, which may result in a claim. Knowledge of an "occurrence" or an offense by your "employees" shall not, in itself, constitute knowledge to you unless any one of your partners, "executive officers", directors or insurance managers shall have actually received notice. To the extent possible, notice should include: (1) How, when and where the "occurrence" took place; (2) The names and addresses of any injured persons and witnesses; and, (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. The following is added to paragraph 2. under SECTION IV -- COMMERCIAL GENERAL LIABILITY CONDITIONS: e. Your rights afforded under this policy shall not be prejudiced if you fail to give us notice of an "occurrence", offense, claim or "suit", solely due to your reasonable and documented belief that the "bodily injury" or "property damage" is not covered under this policy. f. You must see to it that the following are done in the event of an actual or anticipated "covered recall' that may result in "product recall expense": (1) Give us prompt notice of any discovery or notification that "your product" must be withdrawn or recalled. Include a description of your product" and the reason for withdrawal or recall. (2) Cease any further release, shipment, consignment or any other method or distribution of like or similar products until it has been determined that all such products are free from defects that could be a cause of loss under this insurance. ***** 4. Other Insurance The following is added to Other Insurance and supersedes any provision to the contrary with respects to the Commercial General Liability Coverage Part and Products/Completed Operations Liability Coverage Part. O. This Insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (ii)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 6. Representations Replace with the following: By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us, and c. We have issued this policy in reliance upon your representations. Any knowledge of an error or omission in the description of, or failure to completely describe any premises or operations intended to be covered by the Coverage Form will not invalidate or affect coverage for these premises or operations. You must report such error or omission to us as soon as practicable after its discovery However, this provision does not affect our nght to collect additional premium or exercise our right to cancellation or non -renewal. ***** 8. Transfer Of Rights Of Recovery Against Others To Us Replace with the following: 33-0729 10 13 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 6 Used with permission ACS L]R `' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/9/2018 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 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 endorsernellt(s). PRODUCER Clinton Polley Insurance Group, Inc. 12150 Tributary Point Dr #200 Gold River CA 95670 INSURED Coachella Valley Rescue Mission CVRM NMTC Project Holdings P.O. Box 10660 Indio CA 92202 COACH -1 NE:NACT Clinton Polley Insurance Group, Inc. INC. NONo. Exit: 916-984-3400 taFn Net 916-984-3100 ADD certificates1 clintanpailey.Com INSURERIS) AFFORDING COVERAGE NAIC 8 INSURERA: NEWYORK MARINE & GNRL INS CO 16608 INSURER B I INSURER C : INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1994065780 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUF INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM IIVSft j AOUCY EXP LTR TYPE OF INSURANCE J IMMreD/YY Y A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: RO- POLICY JE LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE DED I {RETENTOMS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE n OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If y88, da8crihe under DESCRIPTION OF OPERATIONS below _INSD N/A SUER WVD Y POLICY NUMBER aLlog YYYS WC201700011508 I 7/1/2017 7/1/2018 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may Ae attached If more space is requl A waiver of subrogation is granted to the certificate holder as per the attached endorsement. REVISION NUMBER: ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, i. LIMITS EACH OCCURRENCE $ A FREMIS€S {Ea occurtedcel 8 MED EXP (Any one person) 5 PERSONAL & ADV INJURY S GENERAL AGGREGATE S PRODUCTS- COMP/OP AGG 5 5 COMBINED SINGLE LIMIT {Ea accident] $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRDPER'fY DAMAGE _jeer accident) $ $ EACH OCCURRENCE $ AGGREGATE __- 5 X 5 ATIJTE OTH- ER EACH ACCIDENT $1.000,000 EL DISEASE - EA EMPLOYEE 51.000.000 E.L. DISEASE - POLICY LIMIT $1,000,000- ed) CERTIFICATE HOLDER CANCELLATION City of La Quinta & La Quinta Housing Authority 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 5.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description City of La Quinta City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 Job Name/Contract Number: MOU 47470 Van Buren St. Indio, Ca. 92201 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 2017-07-01 Insured Coachella Valley Rescue Mission Insurance Company New York Marine and General Insurance Company / 28746 Policy No. Endorsement No. WC201700011508 Countersigned By WC 04 03 06 (Ed. 04-84) ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.