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Insurance Certificates 2019/20 Data Ticket� i¢DATE ,acorzr� CERTIFICATE OF LIABILITY INSURANCE (MMIDD/YYYY) 1 04/24/2020 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 Ashbrook-Clevidence, Inc. 3000 W MacArthur Blvd, Suite 320 Santa Ana, CA 92704 License #: 0188788 Mitch Clevidence m AFFORDING COVERAGE ac, Not: (714)979-2809 INSURED Data Ticket, Inc. INSURERB: SC ttsdal 1 nce CoMpgny 41297 DBA Revenue Experts INSURER C: 2603 Main Street Suite 300 INSURER D: Irvine, CA 92614 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00012154-8821372 REVISION NUMBER: 40 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 MAYBE 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. LTR TYPE OF INSURANCE INSD SllDI% POLICY NUMBER MM/DDPOLIC� M�ID=P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE OCCUR DA 70 }2EiJiED PREMISES Ea ocrLrreoce 5 MED EXP (Any one persoro S PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY D PRO- 7 LOC PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY CAM ED SINGLE LIMIT Eaa[ra'dri S BODILY INJURY (Per person) _ $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY I PROPERTY DAMAGE _Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 I EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIA)31UTY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA 7ATUTE ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE S (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below - EL DISEASE - POLICY LIMIT S A I Errors & Omm ' 287188360 11/01/2019 11/01/2020 Ded. $10K $2,000,000 B Cyber Liability EKS3310459 11/01/2019 11/01/2020 1 Deduct $25K $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate evidences Professional Liability (Errors & Omissions) & Includes Personal Injury with $1,000,000, Crime (provided by Travelers Casualty & Surety Company of America NAIC #31194) with $1,000,000 CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by MXC on April 24, 2020 at 02:52PM ACORa ka.� CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 1 3/23/2020 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 CONTACTnette L (Lynn) NAME: y (yn ) Eye PIA Select Insurance Solutions HONK Ext (805) 975-3531 (ac, No): ADDRESS: lynn.eye@piaselect.com 1100 Industrial Rd., #3 INSURER(S) AFFORDING COVERAGE NAIC # San Carlos CA 94070 INSURER A : Amco Insurance Company 002014 INSURED INSURER B : Employers Insurance Group 10346 Data Ticket, Inc. INSURER C : DBA: Revenue Experts INSURER D : 2603 Main Street, Ste. 300 INSURER E : INSURER F : Irvine CA 92614 COVERAGES CERTIFICATE NUMBER- REVISION NIIMRFR- 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE EXI OCCUR Y ACP BPO 3059509589 11/01/2019 11/01/2020 EACH OCCURRENCE S 2,000,000 PREMISES (Ea occurrence) S 30Q000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY S Excluded GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC OTHER: GENERAL AGGREGATE S 4,000,000 PRODUCTS - COMP/OP AGG S 4,000.000 S A AUTOMOBILE LIABILITY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED AUTOS ONLY /► AUTOS ONLY ACP BPO 3059509589 11/01/2019 11/O1/2020 COMBINED SINGLE LIMI I accident) (EaANY S 1,000.000 BODILY INJURY (Per person) S XHIRED BODILY INJURY (Per accident) S rR707= DAMAGE (Per accident) S S ,A X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE ACP CAA 3059509589 11/01/2019 11/01/2020 EACH OCCURRENCE S 2,000,000 AGGREGATE S 2,000,000 DED RETENTION S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) f es, describe under DESCRIPTION OF OPERATIONS below NIA EIG2869443 07/12/2019 07/12/2020 v ) STATUTE ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is agreed the Certificate Holder listed below is included as Additional Insured including Waiver of Subrogation and Primary & Non -Contributory wording as required by written contract. Workers Compensation includes a blanket Waiver of Subrogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quinta CA 92253� AUTHORIZED REPRESENTATIVE ti o R _� © 1988-2015 ACORD COffORATION. All rights reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB 04 4811 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following is added to Section II. WHO IS AN INSURED: Any person or organization shown in the Schedule of this endorsement is also an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III. LIMITS OF INSURANCE AND DEDUCTIBLE: 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. C. This insurance, including any duty we have to defend "suits", does not apply to: 1. "Bodily injury" or "property damage" that arises out of, in whole or in part, or is a result of, in whole or in part, the active negligence of the additional insured shown in the Schedule of this endorsement. 2. "Personal and advertising injury" that arises out of any independent "personal and advertising injury" offense committed by the additional insured shown in the Schedule of this endorsement. All terms and conditions of this policy apply unless modified by this endorsement. Name Of Person Or Organization: PB 04 48 11 14 SCHEDULE Includes copyrighted material of Insurance Services Office, Inc.. with its permission. Page 1 of 1 ACP BPO 3059509589 AGENT COPY 47 25990 .4c n0 CERTIFICATE OF LIA THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY A CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT., If the certificate holder is an ADDITIONAL INSURED, the p If SUBROGATION IS WAIVED, subject to the terms and conditions of the this certificate does not confer rights to the certificate holder In lieu of s PRODUCER PIA Select insurance Solutions 1100 Industrial Rd., #3 San Caries CA 94070 INSURED Data Ticket, Inc. DBA: Revenue Experts 2603 Main Street, Ste. 3D0 Irvine CA 92614 COVERJA BILITY INSURANCE DATE(MMIODNYYY) A vIicy(ies) uch 7:9i2020 ND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED must have ADDITIONAL INSURED provisions or be endorsed. policy, certain policies may require an endorsement. A statement on endorsement(s). NAME: Lynette (Lynn) Eye P-UFAX aIC Ho Ext : (905) 975-3531 wc, No}: ADDRESS: 1,,rin-eye@piasclect.com INSURER(S) AFFORDING COVERAGE NAIL A INSURER A : Amco lnsurancc Company 002014 INSURER B : Employers Insurance Group 10346 INSURER C INSURER D : INSURER E fNSURERF: GES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT FOR THE POLICY PERIOD WITH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IS SUBJECT TO ALL THE TERMS, LTR TYPE OF INSURANCE INSO WVO POLICY NUMBER (MMMDfYYYYI {MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LlA9ILSTY CLAWS -MADE FKIOCCUR EACH OCCURRENCE S 2,000,000 Pi E5MISES IEa o=rrc eau s 36n,nnn MED E: XP (Any one person) S 5,000 PERSONAL s ADV INJURY 5 Excluded A Y ACP BPO 3059509589 11/01/2019 11/01/2020 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 PRODUCTS -CDt,AP10PAGG 5 4.000.GDO A POLICY JE T ❑LOC OTHER' 5 AUTOMOBILE LIABILITY LSINLD (Ea S 1,000,000 ANY AUTO BODILY INJURY {Per person) S A AUTOS ONLY AUTOSOWNED ACP ACP BPO 3059509589 11/01/2019 11101/20-10 BODILY INJURY (Per accident) S HIRED y NON -OWNED AUTOS ONLY A AUTOS ONLY (Per accident] S 5 OCCUR UMBRELLA GABHCILAIMS-MADE EACH OCCURRENCE 5 2,000,000 A A EXCESS UAB ACP CAA 3059509589 11/01 "2019 1 1I'OV2020 AGGREGATE S 2,000,000 DED I I RETENTION S $ PORKERS COMPENSAIRON D EMPLOYERS' PER HF- �/a STATUTE ER LIABILITY YIN E.L. EACH ACCIDENT 5 1,000.000 13 Y PROPRIETORr'PARTNER/EXECUTiVE fFRCERWEMBEREXCLUDED? y NIA EIG4581764-00 07/12/2020 1111P2020andatory E.L. DISEASE - EA EMPLOYEE S 1,000,000 In NHy describe under E.L. DISEASE - POLICY LIMIT S L000,000 SGRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aNached if more space to required) It is agreed the Certificate holder listed below is included as Additional Insured including Waiver of Subrogation and Primary & Non -Contributory- wording as required by written contract, Workers Compensation includes a blanket Waiver of Subrogation. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of" Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calle Tampico La Quints CA 92253 1998-2015 ACORD CORPORATION. All rinhta rpCPr Prl ACORD 25 (2016103) The ACORD name and logo are registered marks of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his endorsement modifies insurance provided under the following: PREMIER BUSINESSOW►dERS COMMON POLICY CONDITIONS SCHEDULE Name Of Person Or organization. WHEN REQUIRED BY A WRITTEN CONTRACT in condition K_ TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US, under paragraph 2. Applicable to Businessowners Liability Coverage, the following paragraph is added -- We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for Injury or damage arising out of your ongoing operations or "your world' 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. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Oftzce, Inc., with its permission. @ ISO Properties, Inc., 2404 PB 04 97 07 07 ACP SPO 3059609M AGENT COPY Page 1 of 7 47 17691 ACPBP03059509589 BUSINESSOWNERS PB 60 72 07 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT TO OTHER INSURANCE CLAUSE FOR ADDITIONAL INSUREDS - PRIMARY AND NON- CONTRIBUTORY WHEN REQUIRED IN A WRITTEN AGREEMENT OR CONTRACT WITH YOU This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS Only with respect to any additional insured, in the COMMON POLICY CONDITIONS, form PB 00 09, under condition H. OTHER INSURANCE, paragraph 2.a. is replaced by the following: H. OTHER INSURANCE Under any liability coverage provided by this policy, a. If for injury or loss we cover, there is other valid and collectible insurance available to any additional insured under another policy, our obligations are limited as follows: (1 ) Issued by another insurer, or if there is self insurance or similar risk retention that applies to a loss covered by this policy, then this insurance provided by us shall be excess over such other insurance, unless you have agreed in a written contract or written agreement signed prior to the foss that this insurance shall be primary: (a) Then this insurance is primary. If other insurance is also primary, we will share with all that other insurance as described in d. below; and (b) The coverage afforded by this insurance is non-contributory with the additional insured's own insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured to any other person or organization's policy; or (2) Issued by us or any of our affiliate companies, that applies to a loss covered by this policy, then only the highest applicable Limit of Insurance shall apply to such loss. This condition does not apply to any policy issued by us that is designed to provide Excess or Umbrella liability insurance. All terms and conditions of this policy apply unless modified by this endorsement. PB 60 72 07 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 2 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description With respect to all employees subject to the workers' compensation laws of the state of California, any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This policy is subject to a minimum charge of $250 for the issuance of waivers of subrogation This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. {The Informations below is required only when this endorsement is issued subsequent to preparation of the policy.] This endorsement, effective 07/12/2019 Policy No. EIG 2869443 00 at 12:01 AM standard time, forms a part of Of the EMPLOYERS PREFERRED INS. CO_ Carrier Code 00920 Issued to DATA TICKET, INC. Endorsement No. Premium Countersigned at on By: Authorized Representative WC 04 03 06 (Ed. 4-84) C 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.