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Insurance Certificates 2019/20 Merchants Building Maintenance LLCSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 4/9/2020 Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (626) 799-7000 (626) 583-2117 www.boltonco.com 0008309 Nationwide Mutual Insurance Company (A+XV)23787 Safety National Casualty Corporation (A+ XIV)15105 Federal Insurance Company (A++XV)20281 AMCO Insurance Company (A+XV)19100 Berkshire Hathaway Homestate Ins Co (A++XV)20044 16691Great American Insurance Company (A+XIV) A 1,000,000ACP30187352986/1/2019 6/1/2020 1,000,000 3 0 3 1,000,000 2,000,000 2.000,0003 A ACP3018735298 6/1/2019 6/1/2020 1,000,000 3 D ACP3018735298 6/1/2019 6/1/2020 2,000,00033 2,000,000 0 B SP4054972 Excess WC (CA)6/1/2019 6/1/2020 3 E MEWC127616 (AOS)1/1/2020 1/1/2021 1,000,000 1,000,000 1,000,000 C Fidelity/3rd Party Crime 81585028 6/1/2019 6/1/2020 Limit $1 MIL/Ded. $25,000 A Rented Equipment ACP3008735298 6/1/2019 6/1/2020 Limit: $40,000/item; Ded. $2,500 F Excess Liability - Occurrence TUE257195101 6/1/2019 6/1/2020 $8,000,000 Excess of $2,000,000 Umbrella Cheryl Feia Merchants Building Maintenance LLC 1190 Monterey Pass Road Monterey Park CA 91754 55032406 3 3 GL Additional Insured applies per CG74721216 & CG72461115 attached, only if required by written contract/agreement. XSWC Waiver of Subrogation applies per 0456000113XWC attached. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 Workers Comp is Self-Insured under California Certificate of Consent to Self Insure #1793 for California operations. GL Primary & Non-Contributory Wording applies per CG74721216 attached. Additional Insured(s): City of La Quinta, its officials, employees and agents. 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 1 of 8 CG 74 72 12 16 Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I – Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions of is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III – Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3 Under Section IV – Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke, or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. F. Supplementary Payments Under Section I – Coverages, Supplementary Payments – Coverages A and B Paragraphs 1.b and 1.d. are replaced with: 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 have to 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 loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II – WHO IS AN INSURED Paragraph 3.a. is replaced with: 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; H. Additional Insured – Automatic Status When Required In An Agreement Or Contract With You Section II – Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph 2. a. – d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment – 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(s) or organization(s). This insurance does not apply to any “occurrence” which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises – with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. ACP3018735298 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 2 of 8 CG 74 72 12 16 CG 74 72 12 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new con- struction or demolition operations performed by or on behalf of the person or organization. However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. c. State or Political Subdivision – Permits Relating to Premises – with respect to the following hazards for which the state or political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies. (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (1) “Bodily injury” or “property damage” or “personal or advertising injury” arising out of operations performed for the state or municipality; or (2) “Bodily injury” or “property damage” included within the “products- completed operations hazard”. However, such state or political subdivision’s status as additional insured under this policy ends when the permit ends. d. Owners, Lessees, or Contractors – with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed for that additional insured, whether the work is performed by you or on your behalf. The insurance does not apply to: (1) “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of or the failure to render any professional architectural, engineering, or survey services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, survey, field orders, change orders, or drawings and specifications; or (b) Supervisory, inspection, archi- tectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training, or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of, or failure to render, any professional, architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts, or equipment furnished in connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 3 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 4 of 8 COMMERCIAL GENERAL LIABILITY CG 72 46 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 72 46 11 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured: Ongoing Operations 1. Any person or organization for whom you are performing operations 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; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured for ongoing operations ends when your operations for the person or organization described in Paragraph 1. above are completed. With respect to insurance afforded to these additional insureds for ongoing operations, this insurance does not apply to “bodily injury” or “property damage” occurring after: a. All work, including material, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or b. that operation of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. B. Section II – Who Is An Insured is amended to include as an additional insured: Products–Completed Operations Any person or organization with whom you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by “your work” performed for such person or organization and included in the “products-completed operations hazard”. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering ACP3018735298 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 5 of 8 CG 72 46 11 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. CG 72 46 11 15 of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. D. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1. or Paragraph B.; 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. E. With respect to the insurance afforded to these additional insureds, the following is added to Section IV – Commercial General Liability Conditions, Condition 4. Other Insurance 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 (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. All terms and conditions of this policy apply unless modified by this endorsement. 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 6 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. ACP3018735298 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 7 of 8 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time June 1, 2019 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contrac t that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attach to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No SP4054972 issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to MERCHANTS BUILDING MAINTENANCE COMPANY, ET AL, dated June 1, 2019. SAFETY NATIONAL CASUALTY CORPORATION Secretary President 55032406 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 4/9/2020 11:40:56 AM (PDT) | Page 8 of 8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/26/2019 Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (626) 799-7000 (626) 583-2117 www.boltonco.com 0008309 Cheryl Feia Merchants Building Maintenance LLC 1190 Monterey Pass Road Monterey Park CA 91754 53214631 3 3 GL Additional Insured applies per CG74721216 & CG72461115 attached, only if required by written contract/agreement. Additional Insured(s): City of La Quinta, its officials, employees and agents. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 Workers Comp is Self-Insured under California Certificate of Consent to Self Insure #1793 for California operations. GL Primary & Non-Contributory Wording applies per CG74721216 attached. XSWC Waiver of Subrogation applies per 0456000113XWC attached. A 1,000,000ACP30187352986/1/2019 6/1/2020 1,000,000 3 0 3 1,000,000 2,000,000 2.000,0003 A ACP3018735298 6/1/2019 6/1/2020 1,000,000 3 D ACP3018735298 6/1/2019 6/1/2020 2,000,00033 2,000,000 0 B SP4054972 Excess WC (CA)6/1/2019 6/1/2020 3 E MEWC127616 (AOS)1/1/2020 1/1/2021 1,000,000 1,000,000 1,000,000 C Fidelity/3rd Party Crime 81585028 6/1/2019 6/1/2020 Limit $1 MIL/Ded. $25,000 A Rented Equipment ACP3008735298 6/1/2019 6/1/2020 Limit: $40,000/item; Ded. $2,500 F Excess Liability - Occurrence TUE257195101 6/1/2019 6/1/2020 $8,000,000 Excess of $2,000,000 Umbrella Nationwide Mutual Insurance Company (A+XV)23787 Safety National Casualty Corporation (A+ XIV)15105 Federal Insurance Company (A++XV)20281 AMCO Insurance Company (A+XV)19100 Berkshire Hathaway Homestate Ins Co (A++XV)20044 Great American Insurance Company (A+XIV)16691 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 1 of 8 CG 74 72 12 16 Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I – Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions of is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III – Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3 Under Section IV – Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke, or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. F. Supplementary Payments Under Section I – Coverages, Supplementary Payments – Coverages A and B Paragraphs 1.b and 1.d. are replaced with: 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 have to 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 loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II – WHO IS AN INSURED Paragraph 3.a. is replaced with: 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; H. Additional Insured – Automatic Status When Required In An Agreement Or Contract With You Section II – Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph 2. a. – d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment – 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(s) or organization(s). This insurance does not apply to any “occurrence” which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises – with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. ACP3018735298 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 2 of 8 CG 74 72 12 16 CG 74 72 12 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new con- struction or demolition operations performed by or on behalf of the person or organization. However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. c. State or Political Subdivision – Permits Relating to Premises – with respect to the following hazards for which the state or political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies. (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (1) “Bodily injury” or “property damage” or “personal or advertising injury” arising out of operations performed for the state or municipality; or (2) “Bodily injury” or “property damage” included within the “products- completed operations hazard”. However, such state or political subdivision’s status as additional insured under this policy ends when the permit ends. d. Owners, Lessees, or Contractors – with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed for that additional insured, whether the work is performed by you or on your behalf. The insurance does not apply to: (1) “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of or the failure to render any professional architectural, engineering, or survey services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, survey, field orders, change orders, or drawings and specifications; or (b) Supervisory, inspection, archi- tectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training, or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of, or failure to render, any professional, architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts, or equipment furnished in connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 3 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 4 of 8 COMMERCIAL GENERAL LIABILITY CG 72 46 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 72 46 11 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured: Ongoing Operations 1. Any person or organization for whom you are performing operations 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; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured for ongoing operations ends when your operations for the person or organization described in Paragraph 1. above are completed. With respect to insurance afforded to these additional insureds for ongoing operations, this insurance does not apply to “bodily injury” or “property damage” occurring after: a. All work, including material, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or b. that operation of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. B. Section II – Who Is An Insured is amended to include as an additional insured: Products–Completed Operations Any person or organization with whom you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by “your work” performed for such person or organization and included in the “products-completed operations hazard”. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering ACP3018735298 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 5 of 8 CG 72 46 11 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. CG 72 46 11 15 of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. D. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1. or Paragraph B.; 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. E. With respect to the insurance afforded to these additional insureds, the following is added to Section IV – Commercial General Liability Conditions, Condition 4. Other Insurance 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 (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. All terms and conditions of this policy apply unless modified by this endorsement. 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 6 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. ACP3018735298 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 7 of 8 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time June 1, 2019 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contrac t that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attach to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No SP4054972 issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to MERCHANTS BUILDING MAINTENANCE COMPANY, ET AL, dated June 1, 2019. SAFETY NATIONAL CASUALTY CORPORATION Secretary President 53214631 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.20 OOS WC | Victor Morales | 12/26/2019 5:20:41 PM (PST) | Page 8 of 8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/31/2019 Bolton & Company 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (626) 799-7000 (626) 583-2117 www.boltonco.com 0008309 Cheryl Feia Merchants Building Maintenance LLC 1190 Monterey Pass Road Monterey Park CA 91754 49063769 3 3 GL Additional Insured applies per CG74721216 & CG72461115 attached, only if required by written contract/agreement. Additional Insured(s): City of La Quinta, its officials, employees and agents. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 Workers Comp is Self-Insured under California Certificate of Consent to Self Insure #1793 for California operations. GL Primary & Non-Contributory Wording applies per CG74721216 attached. XSWC Waiver of Subrogation applies per 0456000113XWC attached. A 1,000,000ACP30187352986/1/2019 6/1/2020 1,000,000 3 0 3 1,000,000 2,000,000 2.000,0003 A ACP3018735298 6/1/2019 6/1/2020 1,000,000 3 D ACP3018735298 6/1/2019 6/1/2020 2,000,00033 2,000,000 0 B SP4054972 Excess WC (CA)6/1/2019 6/1/2020 3 E MEWC023295 (AOS)1/1/2019 1/1/2020 1,000,000 1,000,000 1,000,000 C Fidelity/3rd Party Crime 81585028 6/1/2019 6/1/2020 Limit $1 MIL/Ded. $25,000 A Rented Equipment ACP3008735298 6/1/2019 6/1/2020 Limit: $40,000/item; Ded. $2,500 F Excess Liability - Occurrence TUE257195101 6/1/2019 6/1/2020 $8,000,000 Excess of $2,000,000 Umbrella Nationwide Mutual Insurance Company (A+XV)23787 Safety National Casualty Corporation (A+ XIV)15105 Federal Insurance Company (A++XV)20281 AMCO Insurance Company (A+XV)19100 Berkshire Hathaway Homestate Ins Co (A++XV)20044 Great American Insurance Company (A+XIV)16691 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 1 of 8 CG 74 72 12 16 Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I – Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions of is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III – Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3 Under Section IV – Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke, or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. F. Supplementary Payments Under Section I – Coverages, Supplementary Payments – Coverages A and B Paragraphs 1.b and 1.d. are replaced with: 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 have to 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 loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II – WHO IS AN INSURED Paragraph 3.a. is replaced with: 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; H. Additional Insured – Automatic Status When Required In An Agreement Or Contract With You Section II – Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph 2. a. – d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment – 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(s) or organization(s). This insurance does not apply to any “occurrence” which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises – with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. ACP3018735298 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 2 of 8 CG 74 72 12 16 CG 74 72 12 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new con- struction or demolition operations performed by or on behalf of the person or organization. However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. c. State or Political Subdivision – Permits Relating to Premises – with respect to the following hazards for which the state or political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies. (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (1) “Bodily injury” or “property damage” or “personal or advertising injury” arising out of operations performed for the state or municipality; or (2) “Bodily injury” or “property damage” included within the “products- completed operations hazard”. However, such state or political subdivision’s status as additional insured under this policy ends when the permit ends. d. Owners, Lessees, or Contractors – with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed for that additional insured, whether the work is performed by you or on your behalf. The insurance does not apply to: (1) “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of or the failure to render any professional architectural, engineering, or survey services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, survey, field orders, change orders, or drawings and specifications; or (b) Supervisory, inspection, archi- tectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training, or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of, or failure to render, any professional, architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts, or equipment furnished in connection with such work, on the project (other than service, maintenance, or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 3 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 4 of 8 COMMERCIAL GENERAL LIABILITY CG 72 46 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 72 46 11 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II – Who Is An Insured is amended to include as an additional insured: Ongoing Operations 1. Any person or organization for whom you are performing operations 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; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured for ongoing operations ends when your operations for the person or organization described in Paragraph 1. above are completed. With respect to insurance afforded to these additional insureds for ongoing operations, this insurance does not apply to “bodily injury” or “property damage” occurring after: a. All work, including material, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or b. that operation of “your work” out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. B. Section II – Who Is An Insured is amended to include as an additional insured: Products–Completed Operations Any person or organization with whom you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by “your work” performed for such person or organization and included in the “products-completed operations hazard”. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering ACP3018735298 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 5 of 8 CG 72 46 11 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. CG 72 46 11 15 of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. D. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1. or Paragraph B.; 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. E. With respect to the insurance afforded to these additional insureds, the following is added to Section IV – Commercial General Liability Conditions, Condition 4. Other Insurance 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 (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. All terms and conditions of this policy apply unless modified by this endorsement. 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 6 of 8 CG 74 72 12 16 Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 74 72 12 16 (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. However, a person or organization’s status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. – d. described above the following is added to the 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. However, the insurance afforded to such additional insureds a. – d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 3. Primary and Noncontributory – Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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: a. The additional insured is a Named Insured under such other insurance; and b. 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. I. Employee Bodily Injury To Another Employee Under Section II – Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1)(a), (b). and (c) do not apply to “bodily injury” to a co-“employee” in the course of the co-“employee’s” employment by you, or to “bodily injury” to a co-“volunteer worker” while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II – Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III – Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway, or railroad right-of-way. ACP3018735298 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 7 of 8 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time June 1, 2019 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contrac t that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attach to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No SP4054972 issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to MERCHANTS BUILDING MAINTENANCE COMPANY, ET AL, dated June 1, 2019. SAFETY NATIONAL CASUALTY CORPORATION Secretary President 49063769 | MERCH-1 | (1) MBM 6.1.19 renewal and 1.1.19 OOS WC | Nancy Cadwallader | 5/31/2019 5:18:16 PM (PDT) | Page 8 of 8