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Insurance Certificates 2017/18 Martha's Village & Kitchenr 1 fD ACC]RD CERTIFICATE OF LIABILITY INSURANCE L......---- DATE (MMIDOlYYYY} 01/28/2018 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 tho cortlffcato holder is an ADDITIONAL INSURED, the policy([es) must hove ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemenL A statement on thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Garcia Insurance Inc 2090 E. Tahqultz Canyon Way Palm 5prirgs CA 92282 CONTACT ErinJa N'AMEI Y PHONE (700)320.1111(700}320-1115 IA1C, No, 50): (A1C, Nn}: ADDRESS: INSURERISI AFFORDING COVERAGE NAM 9 INSURER AI Phifadelphla Insurance Company COMMERCIAL GENERAL LIABILITY INSURED Martha's Village & Kitchen, Inc. 83791 Date Avenue Indio CA 92201 INSURER B: ZanlihInsurance Company INSURER C: INSURER 0 : S 1,000,000 INSURER E : INSURER F : CERTIFICATE NUMBER: 0L173904825 REVISION NUMBER: THIS IS TO CERTIFY TI -AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 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 AU. THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INsIt 1.111 TYPE OF INSURANCp AUDI 5150 SlJUit 1W I POLICY NUMBER POLICY EFF (MN rOLEYYYY) POLICY EXP (MMIOONYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE X OCCUR "DATACE-117TRENTE1 Piti:MISES(EA occurrence) 100,000 1 MED EXP (My onoporsnn) 1 5,000 A Y Y PHPK1B1924S 03/03/2017 03/03/2018 PERSONAL 6ADV INJURY S 1,000.000 GEN'LAra'G51EGArELimn-APPLIES PER: GENERAL AGGREGATE_ 1 2,000.000 X POLICY n !ECT FRO- LI LOC PRODUCTS - COMPIOPAGO 1 2,000,000 OTHER: Employee Benefits S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ee amden/l 5 1,000,000 ANY AUTO BODILY INJURY (Per person) $ A OWNED AUTOS ONLY X SCHEDULED AUTOS PHPK1815246 03/03/2017 03/03/2018 BODILY INJURY (Per accident) $ _ X WIRED AUTOS ONLY !� NON -OWNED AU'r05 ONLY PROPERTY OMJACG (Por orcldonl) $ Uninsured motorist 3 1,003,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE f 5.000,000 A EXCESS DAB CLAIMS -MADE PHUB574875 03/03/2017 03/03/2018 AGGREGATE $ DEO X RETENTION 3 10,000 3 WORKERS COMPENSATION X PER 001. STATUTE LR AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORA'ARTN5RIEXECUTIVE 03/03/2017 03/03/2018 E.L. EACH ACCIDENT $ 1,000,000 B OFFiCERRAFMI3EREXCLUO£O? ❑ (Mandatory In NH1 NIA Y Z127054103 F E.L. DISEASE - EA EMPLOYEE 5 1,000,000 e yyes, describe under DESCRIPTION OF OPERATIONS (:nlnw E.L. DISEASE..- POLICY LIMIT 5 1,000,000 A Directors and Officers PHSD1225396 03/03/2017 03/03/2018 Each Claim Retention 1,000,000 10,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES IACORD 101, Additional Remarke Schedule, may be attached If more e5a0e le required) La Quanta Housing Authority Is named as additional Insured, Waiver of Subrogation appiles to workers compensation. This Insurance Is primary and non-contributory. •10 day notice of cancellation may be Issued for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION La Oulnta Housing Authrolty 78495 Calle Tampico LA Qulnta 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 lurk ACORD 26 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 CG20010413 (2) 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. © Insurance Services Office, Inc,, 2012 Page 1 of 1 POLICY NUMBER: PHPK1619248 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): LA QUINTA HOUSING AUTHORITY Information required to complete this Schedule, If not shown above, will be shown In the Declarations. 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 with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, in whole or In part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you, However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured Is required by a contract or agreement, the Insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured, .+I". n!' nn PIA AO 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. Thls endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. /Fl In..,.mnnn Ceniinne 1'lffinn Inn 9n19 P,nn 1 of 1 Midterm Endorsement Inception Date; 03/03/2017 Policy Number: Z127054103 DIRECT BILL Branch: 001 Agent Code: 092591A Agent: MAVERICK COMMERCIAL INS. SERVS. 23945 Calabasas Road, Suite 107 Calabasas, CA 91302 Insured: MARTHA'S VILLAGE & KITCHEN, INC. [NON-PROFIT CORP] 83-791 DATE AVENUE INDIO, CA 92201 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY r e WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. 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. Minimum Premium: $0.00 Person or Organization LA QUINTA HOUSING AUTHORITY 78495 CALLE TAMPICO LA QUINTA, CA 92253 RE: CALIFORNIA OPERATIONS Schedule 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 03/03/2017 Insured MARTHA'S VILLAGE & KITCHEN, INC. [NON-PROFIT CORP] Policy No. Z127054103 Policy Period 03/03/2017 To 03/03/2018 Issued On 01/26/2018 At Woodland Hills, CA WC -04-03-06B (Ed. 10-07) ZENITH INSURANCE COMPANY - 13145 Endorsement No. 28