Insurance Certificates 2020/21 Acorn Technology ServicesA� oe CERTIFICATE OF LIABILITY INSURANCE DATE IMxloorcrrr)
3/16/2020
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 INSURI IS),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: If the certl0cate holder is an ADDITIONAL INSURED, ere policylies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endomement. A statement on this certificate does not confer rights to the
certificate holder In Ileu of such endomement(s).
PRODUCER
CONTACT ,Tulia Aybak
RARE
%ellogg A Moreland Agency, Inc. DID,
PHONE 19091792-8950 F^% Po. - a .xo:
Arroyo Insurance services
nooAREss: juliar@arroyoine. com
1654 Plus Lane
INSURER 3 AFFOROINO COVFFAGE
NAIL Y
INSURERA:Bederal Ins Cc
20Z81
Redlands CA 92374-4532
INSURED
INSURERS: AllseriCe Financial Rene£1t Ina CO
41840
INSURER C:
Mighty Oak Technology, DBA: Acorn Technology Services
INSURERD:
1960 Chicago Ave 4E9
INSURE0.E:
INSURER F:
Riverside CA 92507
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO GERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH 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.
ILM
TYPE OF INSURANCE
Fp1CY NUMBER
POLICVEFF
MMNMYVYY
POLICY ESP
POLICY ESP
LIMITS
%
COMME0.CMLOENERALWBILITY
EACH OCCURRENCE
E 1,000,000
A
CIAIMSMAOE ❑R OCCUR
OMM ET o
Eattr+rtmce
PREMISES I.
E 1,000,000
MED EXP Rvy one Smon)
E 10,000
%
3539-95-6B F¢
3/20/2020
3/20/2021
INJURY
6 1, 000, 000
GEH'L
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
6 2,000,000
POLICY PEa LOO
PRODUCTS-COMPIOPAGG
S 2r000,000
„
E 2,000,000
OTHER'
AUTOMOINE LIABILITY
IH
Mllld �
$ 1,000,000
REPLY INJURY IPa,'mm)
s
A
ANY AUTO
BOOT LV INIURY (Per eviEerm
S
ALL OWNED SPUR DIED
AUTOS UTOS
1312-68-66
3/20/2020
3/2012MI
PROPERTY DAMAGE
ersne v
i
% XWEOAUTOS X NON.&.PD
AUTOS
a
A
LmsBJn HASX
LCLUR
EACH OCCURRENCE
9 2,000,000
AGGREGATE
6 2, 000, 000
A
EXCESS UAB
CIAIMSMADE
OEO gETENTION i
E
T963-H-01
3/20/2020
9/20/2021
WORHERS COMPENSATION
AND EMPLOYERS LIABILITY .TIN
OFVPRCPRIETORPARNERUXIIII
% PEP OTX-
STATUTE ER
EL EACH ACCIDENT
E 1,000,000
B
FICERMEM RES EXCLUDEW
UKPdAbry In HI
NIA
1@3-O96II38-00
T/1/2019
]/1/2020
ELDISEASE-EAEMPLOYEE
3 11000,000
R Ves, covert¢ ur.,
DESCRIPTION OF OPERALONS b&wr
ELOISEASE-POIICVOMIT
6 1,000,000
A
Cybei Liffiility
9583-35-60 ACE
3/20/2020
3/20/2021
ImMUWO Anomens UPI
CESCNPTION OF OFERATONS I LOCATIONS I VEHICLES MR ORD 101, AEcsoml Rem,mm S USI mry M nom ec IT mom sWu Is Ipu1M)
"City of La Quints is hereby recognized as additional insured including primary wording per attached form
Mg002236T"
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City OF La Quints
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
78495 Call. Tampico
ACCORDANCE WITH THE POLICY PROVISIONS.
La Quinta, CUR, 92253
ROUNDERS. gEPREswTANVE
Julie Rybak/JULIE
P 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 DVADp
C H U B B, Liability Insurance
Endorsement
Policy Period
MARCH 20, 2020 TO MARCH 20, 2021
E//eclim Date
MARCH 20, 2020
Policy Number
3583-35-68 WCE
Insured
MIGHTY OAK TECHNOLOGY DBA
ACORN TECHNOLOGY SERVICES
Name of Company
FEDERAL INSURANCE COMPANY
Date Issued
3ANUARY 2, 2020
This Endorsement applies m the following forms:
GENERAL LIABILITY
Under Who Is An Insured, the following provision is added
Who Is An Insured
Additional Insured -
Persons or organizations shown in the Schedule are insureds: but they are Insureds only if you are
Scheduled Person
ohligatedpmsuaut to a contractor agreement to provide them with such insurance as is afforded by
Or Organization
this policy.
However. the person or organization is an insured only:
• if and then only to the extent the person or organization Is described in the Schedule;
• to the extent such contractor agreement requires the person or organization an be afforded
slams a an Insured:
• for activities that did not occur, in whole or in part, before the execution of the contract or
agreement: and
• with respect to damages, loss, cost or expense for injury or damage to which this insurance
applies.
No person or organization is an insured under this provision:
• that is more specifically identified under my other provision of the Who Is An Insured
section (regardless of my Bmimtion applicable thereto).
• with respect to my assumption of liability (of mother person or organization)by them in a
contractor agreement.This limitation does act apply to the liability for damages, loss, cos[ m
expense for injury or damage, to which this insurance applies, that the person or organization
would have in the absence of such contractor agreement.
Liability lnaurence Addlaonel Insured- SdwdWed Pazsan Or Oramlraaon omMured
Form ap 367 fRev. fill]) Eadosernent Page I
CHUBS,
Liability Endorsement
(continued)
Under Conditions, the following provision is added to the condition titled Other Insurance.
Conditions
Other Insurance —
If you are obligated,pursuaul to a contractor agreement, to provide the person or organization
Primary, Noncontributory
shown in the Schedule with primary insurance such as is afforded by tuts policy, then in such case
Insurance — Scheduled
this insurance is primary and we will not seek contribution from insurance available such person
Person Or Organization
or organization.
Schedule
CITY OF LA QUINfA
79495 CALLS TAMPICO LA QUINTA, CA 92253
All other terms and conditions remain unchanged.
Aulhorized Represents We Q�
Ilahllity lnsurerar, Additlonel Insured- Sdwdl&d Person Or OrgeMreNon lanpape
Fvrm Bb�-238J (Ray.SWJ Erdmasarant Peas 2
ACb H CERTIFICATE OF LIABILITY INSURANCE
I°°" "2020THIS
MTHIS
CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: Ifthe certificate holder is an ADDITIONAL INSURED, Me policy(ies) must tIo endorsed. If SUBROGATION IS WAIVEDthe terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confthecertificate holder In lieu of such endorsoment(9(.
PRODUCER
Kellogg 6 Mcreland Agency, Inc. DRA
Arroyo Insurance service.
1654 PSUN Lane
Redlands CA 92374-4532
FUNSIFUMEJulie Rybak
PHONEOBNE (909)092-8950p
A.R.E TPlier@arroyoina.com
INSURERSAFFORDING C°VEMGE
NAICA
INSURERA:Federal Ina CO
20281
INSURED
Mighty Oak Technology, DBA: Acorn Technology Services
1960 Chicago AVe kE9
R1V.rside CA 92507
INSURERS: A11IDeriCa Financial P.Ce£it Ina CO
41840
INSURER C:
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. NOTWITHSTANDINGANY REOUIREMENT TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LT0.
TYPE °F INSURANCE
ADDL
SUM
POLICY NUMBER
POIRY OFF
.seen IYY
POLICYEXP
IMMUNN,TAO
LIMITS
MERCMLGENEMLLIABILEY
EACH OCCURRENCE
$ 1,000,000ACIAIMSMADE
10M
F. OCCUR
PREMISES Se P--
$ 1, 000I000
MD. EXP (Mryone ONaln)
S 10,000
X
3533-33-63 F3
V20/2020
3/20/2021
PERSONAL SADV INJURY
S 1,000,000
GEN'LAGGREGATE
LIMITAPPLIESPER'.
GENEMLAGGREGATE
$ 2,000,000
POLICY PRO ❑ LEE
JECT
PRODUCTS- COMP/OPAGG
b 2,000,000
6 2,000,000
OTHER'.
AUMM°BILE LIABILSTY
CEOMBwIN6E MSINGLE LIMIT
6 1,000,000
BODILY INJURY (Px P-)
S
ANYAUTO
A
BODILY INJURY IPx avdenO
S
ALL E. SCHEDULED
IS52-60-66
3/20/2020
3/20/2021
AUTOS AUTOS
P.I..OPORa aAMAGE
$
'Y XIREOAUTOS N 'URGE
S
X
UMBRELLALMB
X
OCCUR
EACH OCCURRENCE
6 2 000 COO
AGGREGATE
S 2 000 000
A
EXCESS LIAO
CIAIMS-MADE
DEC
RETENTION S
$
T983-2T-01
3/20/2020
3/20/2021
YIORNERS COMPENSATION
A- PER OTH
STATVTE ER
AND EMPLOYERS' LMBIUTY T,/
ANY RTNEEDXECUTIVE
El, EACH ACCIDENT
$ 1, COO, DOD
OFFICERmFMNFx
N/A
.L. DISEASE-FAEMPLOYEE
8 1,001,000
E
(Mmtlavgin NHS
y
W3ro961238-01
7/1/2020
7/1/2021
1 vse aeamM Mar
E.L. DISEASE POLICY LIMn
$ 1,000,000
DESCRIPTION OF OPERATIONS EeIaw
A
Cybet Liability
3m8 -M-66 RAN
3/20/2020
3120/2021
lo.000.oXID.S...I
IACOM101,AEJi6malRemabSCM6ule,mayGa h. MmmespewIcnquimdI
is hereby recognized as additional insured including primary wording per attached form
7LOCATIONIIVEHICLEIHICLES
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
78495 Calla Tamp±co ACCORDANCE WITH THE POLICY PROVISIONS.
La Quinta, CA 92253
AUTHOPUED REPRESENTATIVE
Julie Rybak/SOLIE 4a
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
Hanvr`In,
W23 D961238 1001674
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTLAUFORNIA
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 Job Description
CITY OF LA QUINTA 78495 CALLE TAMPICO
LA QU I NTA, CA 92253
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. W23-D961238-01 Endorsement No.
Insured
Insurance CompanyALLMERICA FINANCIAL BENEFIT INSURANCE I/I/^^1111
Countersigned By i
WC D4 03 06 (Ed 04-84)