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Insurance Certificates 2019/20 Southwest AquaticsAcQRb' CERTIFICATE OF LIABILITY INSURAVCE �� DATE(Y) 08127//201019 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Lynn Holm RISI, dba Pan American Insurance Services A& No E t : (760)772-1700 pIC, No : (760)772-1775 ADDRESS- lynn,holm@relationinsurance.com 77-851 Las Montanas Rd, Ste B INSURER(S) AFFORDING COVERAGE NAIC # Palm Desert CA 92211 INSURERA : Certain Und at Lloyds, London INSURED INSURER B: General Casualty Company of Wisconsin 24414 Desert Limnologists, Inc INSURERC: Zenith Insurance Company 13269 DBA: Southwest Aquatics INSURER D : Platte River Ins Co 18619 PO Box 13212 INSURER E Palm Desert CA 92255 INSURER F : COVERAGES CERTIFICATE NUMBER: 2019 WC/GL/Auto 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 CONTRACTOR 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. 1 TR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF ( MMIDD/YYYY) POLICY EXP MMIDD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 2,000,000 CLAIMS -MADE Fx OCCUR PREMISES Ea occurrence) s 100,000 MED EXP (Any one person) s 5,000 PERSONAL & ADV INJURY $ 2,000,000 A EC0055617OR3 09/01/2019 09/01/2020 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 4,000,000 x JFERO �LOC POLICYE PRODUCTS $ 4,000,000 Pollution Liability $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COM131NED SINGLE LIMIT Ea eocident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED x SCHEDULED AUTOS ONLY AUTOS BCA000386000 09/01/2019 09/01/2020 BODILY INJURY (Per accident) $ x HIRED x NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Paraccid9nl $ Uninsured motorist s 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE s AGGREGATE s EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- C AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Z133313204 04/01/2019 04/01/2020 x STATUTE ER E L. EACH ACCIDENT s 1,000,000 E.L.DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 CSLB Bond D 41047527 02/12/2019 02/12/2021 Limit $15,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SUPERCEDES CERTIFICATE ISSUED 3/25/2019 Certificate holder is listed as an Additional Insured and coverage is Primary & Non -Contributory, per form BW-EILPACK-0005A, as related to General Liability. Waiver of Subrogation applies per form WC-04-03-06B as respects to workers' compensation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico AUTHORIZED REPRESENTATIVE La Quinta CA 92253 f ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD