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Insurance Certificates 2018/19 Terra NovaACORL?� DATE (MWOONYYY) CERTIFICATE OF LIABILITY INSURANCE 06/26/2019 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 pollcy(les) 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 $tateFaR1f TIMOTHY WOOD, LIC# 0697033 35963 DATE PALM DR. ciw& c CATHEDRAL CITY. CA 92234 COUTACT JOVANY M. CALVILLO I LIC# OG40189 SaML PHONE Tom,'. - - ICI_ Nd , 760-770-9282 aM"ISS JOVANY.M,CALViLLO.tNJS[d�STATEFARM.COM INSURER(S) AFFORDING COVERAGE I NAIC N INSURER A: State Farm General Insurance Company 25151 INSURED TERRA NOVA PLANNING & RESEARCH, INC. 42635 MELANIE PLACE STE 101 PALM DESERT, CA 92211 INSURER B; Slate Farm Mutual Automobile Insurance Company 25178 INSURER C: I INSURER D: INSURER E: 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, i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR I OF INSURANCE ADDLITYPE wen SUn POLICY NUMBER iIHMrLIDCY EFF mmoo EkP LIMITS I A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR Y Y 90-BP-0066-0 08/01/2018 08/01 /2019 EACH OCCURRENCE S 2,000,000 CW PREMISES 7omMr ' S 300.000 MED EXP LA.. one person) S 5,000 PERSONAL 6 ADV INJURY f 2,000,000 GWL AGGREGATE LIMIT APPLIES PER; POLICYEJ JET LOC OTHER: GENERAL AGGREGATE S 4.000.000 PRODUCTS - COMPIOP AGG S 4.000,000 f B AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y Y 248 9932-F29-55 08/01 /2018 08/0112019 COMBINED SINGLE LIMIT rEa eui l S 1.000,000 BODILY INJURY (Per permn) S BODILY INJURY (Per accident) S PR P TY MA cddenl OA S f UMBRELLA UAe EXCESS UAB CLAIM"ADE EACH OCCURRENCE Is HOCCUR AGGREGATE s DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRI ETO RrPARTN EWEXECUTIVE a OFFICERNEMBER EXCLUDED? (MandatoryIn NH) 1r yes. de suite under OESCWPTiON OF OPERATIONS below NIA P RT -E I ER E.L- EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, nay be attached H more space Is requlrod) THE CITY OF LA QUINTA, ITS OFFICERS, EMPLOYEES, CONTRACTORS, AND AGENTS ARE COVERED AS ADDITIONAL INSURED. POLICY IS PRIMARY AND NON-CONTRIBUTORY, AND WAIVER OF SUBROGATION APPLIES. 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 REP ENT E LA QUINTA, CA 92253 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 2512016/03) The ACORD name and logo are rt¢+sFered marks of ACORD 1001486 132849.12 03-16-2016 ,�tc'o►�a� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/26/2019 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 pollcy(les) 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 Ileu of such endorsement(s). PRODUCER Hall & Company A/E Insurance Services 19660 10th Ave NE CONTACT NAME: McKenzie Martonik PHONE _1A_rC IVI. ): 360-626-2023 ac,Nc::3fi0 62B 2023 n PRESS: mmarton( hallandooM ny.com Poulsbo WA 98370 INSURERIS AFFORDING COVERAGE NAIC # INSURER A: Underwriters at Lloyd's, London INSURED TERRNOV-01 Terra Nava Planning & Research Inc 42635 Melanie PI Ste 101 INSURER B : INSURERC INSURER D : Palm Desert CA 92211 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER:1897597291 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 R` EDUCED BY PAID CLAIMS. INSR L TYPE OF INSURANCE ,ADDL BR I POLICYNUMBER I mnl3rxI fMMii0DDPOLIC1lYYY 1 LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR EACH OCCURRENCE $ b GEN'LAGGREOATE PREMISES,[Ea.occurmncol MED EXP (Any one person) $ PERSONAL &ADV INJURY GENERAL AGGREGATE $ LIMITAPPLIES PER: RO- POLICY 1 JECT n LOC OTHER: $ PRODUCTS - COMP/OPAGG $ I $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY I AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY iD;41B1 EG L I iT fEa aocltlanA $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) _ PROPERTY GE accident $ .$ $ , UMBRELLA LAB EXCESS LIAB �_ OCCUR CLAIMS -MADE . EACH OCCURRENCE $ s AGGREGATE 1-1 DE21 I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPRCPRIETORPARTNERrEXECUTIVE Y OFFICERJMEMBER EXCLUDED? (Mandatory In NHr If as, dosorbo under DEYSCRIPTION OF OPERATIONS bolaw N/A IPER O H- STATUTE ZR E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ $ E.L DISEASE- POLICY LIMIT A Professional Llab;Clelms Made Contractors Pollution Liability$2,000,000 ENP000201802 11/512018 1 11/6I2019 $2,000,000 Per CIeIm Per CIeIm $2,000,000 Aggre $2,000,000 Aggre DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attaahed If more space Is required) UAI UMLLA I IUN SHOULD ANY OF THE ABOVEDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of La Quinta 78-945 Calle Tampico La Quinta CA 92253 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD --li A,C"R�`�� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYW) 14-1�8/10/2018 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 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 SWAMIV(rsement(s). PRODUCER NAME: Heather Harris (Hall & Company PHONE 360-598-5026 FAX A/E Insurance Services E MA,r. Nn : 360-598-3703 19660 10th Ave NE APPOR99• hharris@hallandcompany.com iPoulsbo WA 98370 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Underwriters at Lloyd's London Syndicate #2623 INSURED TERRNOV-01 INSURER B : Terra Nova Planning & Research Inc INSURER C : 42635 Melanie PI Ste 101 Palm Desert CA 92211 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 599687040 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 r,uUL yUtlK POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE II OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jRo- LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAR I CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liab;Claims Made Contractors Pollution Liability DAMAGE -TO RENTED PREMISES (Ea occurranrP) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ 4UMdi NEU SI NGLir LI MI I $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ u2 E r UmvAAGE $ (Per accldI41 EACH OCCURRENCE AGGREGATE PER I ERH E.L. EACH ACCIDENT $ E-L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ ENP0002018-01 11/5/2017 11/5/2018 $2,000,000 Per Claim $2,000,000 Aggre / $2,000,000 Per Claim $2,000,000 Aggre V 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 City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78-945 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. 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 StateFarm 90-BP-D066-0 007706 A. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-BP-DO66-0 Named Insured: TERRA NOVA PLANNING & RESEARCH INC 42635 MELANIE PL STE 101 PALM DESERT CA 92211-9113 Name And Address Of Additional Insured Person Or Organization: CITY OF LA QU.INTA 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 CM P-478C,.1 Page 1 of 2 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or organization shown in the Schedule, but only ment, the insurance provided to the with respect to liability for "bodily injury additional insured will not be broader than "property damage", or "personal and advertis- that which you are required by the contract fng injury" caused, in whole or in part, by: or agreement to provide far such addition- a. Ongoing Operations al insured; and (1) Your acts or omissions; or c. If the contract or agreement between you and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the in the performance of your ongoing opera- lions for that additional insured; additional insured is the lesser of that which: or b. Products —Completed Operations (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Ca(i- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- foilowing; tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; tiI a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 90-BP-DO66-0 007706 CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION I — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most an,ce the additional insured has for de- ws will ppay on behalf of the additional insured fense or damages for which we would will be thle lesser of the amount of insurance: provide coverage under SECTION II — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - ditional insured, the following replaces SEC- Insurance shown in the Declarations. TION 11 —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional Insured, this insur- ance Is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim, To the sured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. StateFafm 90-BP-DO66-0 007730 CMP-4787 s s Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-BP-DO66-0 Named Insured: TERRA NOVA PLANNING & RESEARCHINC 42635 MELANIE PL STE 101 PALM DESERT CA 92211-9113 Name And Address Of Person Or Organization: CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under 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. All other policy provisions apply. CMP-4787 ®, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office. Inc., with its permission. I DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0914/2018 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 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). CONTACT Kelli Foreman PRODUCER I State Compensation Insurance Fund PHONE FAX P.O. Box 8192 I (AIC.No. Ext): 677-405-4545 iA,C. to,l: Pleasanton, CA 94588-8792 I E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURER A: State Compensation insurance Fund 35076 TERRA NOVA PLANNING AND RESEARCH I INSURER B: 42635 MELANIE PLACE SUITE 101 I INSURER C: PALM DESERT, CA 92211 (INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 5700726808 4 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. Limits shown are as requested INSR TYPE OF INSURANCE LTR COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR Employea Benefits Liability Contractual LiabTiy Included GEN'L AGGREGATE LIMITAPPLIES PER: ❑PRO- ❑ POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY ANYAUTO ADOL SUER D WVO POLICY NUMBER 11 POLICY EFF POLICY EXP LIMITS rMM1DDITYYYI rMMIDOlYYYYI EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERALAGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT !Ea accident) 1 BODILY INJURY ( Per person) OWNED SCHEDULED I BODILY INJURY (Per accident) _ AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED I (Per acudentl ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE EXCESS LAB H CLAIMS -MADE I AGGREGATE OED� IRETENTIDN l A WORKIJ S COMPENSATION AND 9066678-2018 09/01/2018 09/01/20191 X I PER JOTTH- EMPLOYERS' LIABILITYER YIN STATUTE AN PROPRIETOR / PARTNER / EXECUTIVE FiT] EL, EACH ACCIDENT I OFFICER/MEMBER EXCLUDED! NIA (Mandatory in NH) I E.L. DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHIC-ES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 11,000,000 $1,000,000 S1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of La Qui nta AUTHORIZED REPRESENTATIVE 78-495 Calle Tampico La Quinta CA 92253 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD m m N r 0 O Z r t0 zE ' d 0 CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-01-2018 CITY OF LA QUINTA SP 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 GROUP: POLICY NUMBER: 9066678-2018 CERTIFICATE ID: 52 CERTIFICATE EXPIRES: 09-01-2019 09-01-2018/09-01-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2013 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER TERRA NOVA PLANNING & RESEARCH,INC. SP 42635 MELANIE PL STE 101 PALM DESERT CA 92211 M0408 (REV.7-2014) PRINTED : 08-16-2018 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 1, 2018 AT 12 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING SEPTEMBER 1, 2019 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME TERRA NOVA PLANNING & RESEARCH 42635 MELANIE PL STE 101 PALM DESERT, CA 92211 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 9066678-18 RENEWAL SP 2-16-96-17 PAGE 1 OF NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT /IVE SCIF FORM 10217 (REV.7.2014) JULY 23, 2018 1114M,11 PRESIDENT AND CEO 2572 OLD DP 217 1