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Insurance Certificates 2019/20 Old Town Artisan StudioDATE (MM/DD/YYYY) ACORl7� CERTIFICATE OF LIABILITY INSURANCE 1 08/30/2019 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 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 CONTACT NAME: Ron Henderson Ron Henderson Insurance Agency -PHONE n Ext]; (760) 773-0178 p Ngr, (780) 773-5356 73185 Hwy 111, Ste D ADDREss: renderson@fanTlersagent,com Palm Desert INSURED Old Town Artisan Studio 78046 Calle Barcelona CA 92260 I INSURERA: MID CENTURY INS CO 21687 La Quinta CA 92253 I INSURERF: I J rr)VF'RArFC rFRTIFIrATF NIIMRFR• RFVlQlnld IJIIMRFR- 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 1IN SD. } D POLICY NUMBER MM%DDY LTR /YYYY) IMMiDDfYYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE OCCUR A $ES�EN N I LIJ nc�) S 1,000,000 MED EXP JAny one person) S 10.000 Y 606264446 02/17/2019 02/17/2020 A Y PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 X POLICY jMCOT: 171 LOC PRODUCTS - COMP/OPAGG S 2,000,000 S OTHER: AUTOMOBILE LIABILITY MBINEDarxldenl 51NGLE LIMIT COEa S 1,000,000 BODILY INJURY (Per person) S ANY AUTO A OWNED SCHEDULED X AUTOS ONLY AUTOS Y Y 606264446 02/17/2019 02/17/2020 IX BODILY INJURY (Per accident) S - PROPERTY DAMAGE POracpdanl S HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 AGGREGATE S A EXCESS LIAB CLAIMS -MADE 606616601 22/17/2019 02/17/2020 DIED I X RETENTIONS 10,000 S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N TRT E OTFi EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N / A EL DISEASE - EA EMPLOYE S (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT S i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) 78034-78030-78026, CALLE BARCELONA, LA QUINTA, CA 92253 Certificate Holder named as additional insured per policy provisions with waiver of subrogation CERTIFICATE HOLDER City of La Quinta 78495 Calle Tampico La Quinta ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA 92253 12-1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PO LI CY N U M B E R: 606264446 FARMERS INSURANCE ADDITIONAL INSURED -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERSCOMMON POLICY CONDITIONS j6840 2nd Edition With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location Of Covered Operation(s): Effective Date Of Endorsement: CITY OF LA QUINTA 78046 CALLE BARCELONA LA QUINTA, CA 92253 07/30/19 If no entry appears above, information required to complete this endorsement will be shown in the Declarations. The BUSIN ESSOWN ERS LIABILITY COVERAG E FORM is amended as follows: A. With respect to the additional insured described in Paragraph B. of this endorsement, the following exclusions are added to Paragraph 1. Applicable To Business Liability Coverage under Section B. Exclusions: This insurance does not apply to: 1. "Bodily injury" or "property damage" for which the additional insured(s) is obligated to pay damages by reason of the assumption of liability in a contractor agreement. This exclusion does not apply to liability for damages that the additional insured(s) would have in the absence of the contractor agreement. 2. "Bodily injury" or "property damage" occurring after: a. Your ongoing operations at the location of covered operations other than service maintenance or repairs performed by you or on your behalf have been completed; or b. The portion of your ongoing operation out of which the "bodily injury" or "property damage" arises has been putto its intended use by any person or organization. But in no event shall this insurance applyto "bodily injury" or "property damage" arising out of your operations that were completed priorto the effective date of this endorsement. 3. "Bodily injury" or "property damage" arising out of any act or omission of the additional insured(s) or any of its "employees", agents or contractors other than you, except for general supervision by the additional insured(s) of your ongoing operations performed for that additional insured. 4. "Property damage" to: a. Property owned, used or occupied by or rented to the additional insured(s); b. Property in the care custody or control of the additional insured(s) or over which the additional insured(s) exercise physical control; or c. Any work including materials, parts or equipment furnished in connection with such work which is performed forthe additional insured by you. J6840-ED2 09-18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 93-6840 J6840201 B. Section C. Who Is An Insured is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only to the extent that the additional insured(s) is held liable for "bodily injury" or "property damage" caused in whale or in partby: 1. Your ongoing operations performed for such person or organization at the location designated above; 2. The acts or omissions of your subcontractors acting on "your" behalf on the scheduled project in the performance of your ongoing operations for the additional insured(s) which start and are completed within the effective period of this endorsement; or 3. The acts or omissions of such additional insured(s) in connection with its general supervision of such operations. C. With respect to this endorsement, "wrap up policy" means an Owner or Contractor Controlled Insurance Program providing one or a series of policies designed to cover a specific construction project that insures all of the persons and entities working on such project. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended as follows: A. With respect to the additional insured described in Paragraph B. of this endorsement, Section H. Other Insurance is replaced by the following: H. Otherinsurance 1. Primary and Noncontributory Insurance The coverage provided to an additional insured under this endorsement shall be primary and noncontributory ONLY to any insurance issued directly to the additional insured if: a. The Named Insured agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis; b. Such written contractor written agreement referenced in a. above was executed prior to the issuance of this endorsement; c. The additional insured designated herein has a policy with an Other Insurance provision making that policy excess; and d. There is no "wrap up policy" in effect for the work performed at the location designated in the Schedule of this endorsement. 2. Excess Insurance If there is other valid and collectable insurance available to the additional insured(s) as an additional insured under other policies covering the work performed at the location designated and described in the schedule of this endorsement, this insurance will be excess overthose policies. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. 16840-ED2 09-1 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 93-6840 J6840202 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, AhFARMERS INSURANCE WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COMMON POLICY CONDITIONS SCHEDULE Name of Person Or Organization: CITY OF LA QUINTA E0012 2nd Edition Information required to complete this Schedule, ifnot shown above, will be shown in the Declarations. The following is added to Condition K. Transfer Of Rights Of Recovery Against Others To Us: 3. We waive any right of recovery we may have against thu person or organization shown in the Schedule above because of payments we make For injuy or damage arising out of your ongoing operations or "your work" done under a 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 above. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. 914012 2ND EDITION' 10-10 Includes copyright material of Insumuce Senk%olbce, Inc, with its permission E0012201 PAGE. I OF I E0012-ED2 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYY`/) 08/28/2019 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 policy(ies) must be endorsed. If SUBROGATIONIS 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 CONTACT NAME: AUTOMATIC DATA PROCESSING INS AGCY PHONE (877) 287-1316 EAT (888) 443-6112 76250875 (AIC, No, Ext): I IAIC, No): 1 ADP BLVD M/S 625 E-MAIL ADDRESS: ROSELAND NJ 07068 INSURER(S)AFFOROING COVERAGE NAICN INSURER A: Hartford Ins Co of the Midwest 37478 INSURED INSURER B : OLD TOWN ARTISAN STUDIO INSURER C : .78046 CALLE BARCELONA STE 1 LA QUINTA CA 92253 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE A DL SUBR POLICY NUMBER POLICY E;:v POLICY Face LIMITS N WVO IDDIYYYY IMrJVDDTr LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE GE TO CLAIMSTIAADI=❑OCCUR PREMISES fb ccc`r.0 MED EXP (Any one person) PERSONAL 6 RDV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY❑ PRO- ❑ LOG JECT PRODUCTS - COMPIOPAGG OTHER GLELIMTAUTOMOBILE LIABILITY ANY AUTO ZBODILYINJURY Y (Per person)ALL OWNED SCHEDULED Y (Per accident) AUTOS AUTOS NON-OWNEDAMAGE ,HIRED AUTOS AUTOS OGCUR EACH OCCURRENCF UMBRELLA LIAB EXCESS LIAB CLAIMS- AGGREGATE MADE DED I RETENTION $ WORKERS COMPENSATION _ X PER OTH- T R AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY YIN PROPRIETORIPARTNERIEXECUTIVE NIA X 76EGAASMGT 01/01/2019 01/01/2020 E.L.DISFASE-EAEMPLOYEE $1.000.000 W OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTEON OF OPERATIn S below OESCRIATION OF OPERAT7OMS ILOC,A77ONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our Right to Recover from Others Endorsement WC040306 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE13 POLICIES BE CANCELLED The City of La Oumla BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 78495 CALLE TAMPICO IN ACCORDANCE WITH THE POLICY PROVISIONS. LA QUINTA CA 92253-2839 AUTHORIZED REPRESENTATIVE L' ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2016/03) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG AA8MGT Endorsement Number: Effective Date: 01/01/19 Effective hour is the same as stated on the Inform :ti❑n Page of the policy. Named Insured and Address: OLD TOWN ARTISAN STUDIO 78046 CALLE BARCELONA STE 1 LA QUINTA CA 92253 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule_ (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization The City of La Quinta 78495 Calle Tampico La Quinta CA 92253 Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/22/18 Job Description 001 Authorized Representative Policy Expiration Date: 01/01/20