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Insurance Certificates 2020/21 Southwest AquaticsAC"RDl` CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) 08/31 /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 CONTACT Lynn Holm NAME; y RISI dba Pan American Insurance Services AIC"ram Ext : (760) 772-1700 n1, No): (760) 772-1775 77-851 Las Montanas Road E-MAIL Iynn. holm@relationinsurance.com ADDRESS: INSURERIS) AFFORDING COVERAGE NAIC # INSURERA: Certain Underwriters at Lloyds Palm Desert CA 92211 INSURED INSURERS: Infinity Select Insurance Company 20260 INSURER c : Zenith Insurance Company 13269 Desert Limnologists, Inc. DBA: Southwest Aquatics INSURER D : Platte River Ins Co 18619 INSURER E : PO Box 13212 INSURER F Palm Desert CA 92255 COVERAGES CERTIFICATE NUMBER: 2020 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 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. INSR LTR TYPE OF INSURANCE 1NSD WVD POLICY NUMBER POLICY EFF MMIDDIY POLICY EXP MMIDDIYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE Fx_] OCCUR PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 A EC00556170R4 09/01/2020 09/01/2021 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG g 4,000,000 Pollution Liability $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amdeni $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 504610143537001 09/01/2020 09/01/2021 BODILY INJURY (Per accident) $ x PROPERTY DAGE Per aocldertAM $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Uninsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Z133313205 04I01(2020 04/01/2021 X STA UTE EORH E L EACH ACCIDENT $ 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 02/12I2021 Limit $15,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 92253A6" ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD s ADDITIONAL INSURED ENDORSEMENT -OWNERS, LESSEES OR CONTRACTORS (PRIMARYAND NON-CONTRIBUTORY) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART Name of Person or Organisation Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For the purposes of this endorsement, Section II. WHO IS AN INSURED is amended to include as an insured the person or organization shown in the SCHEDULE above, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following paragraph is added to Section I COVERAGES Paragraph 2. EXCLUSIONS: This insurance does not apply to bodily injury or property damage occurring after: (1) 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 site of the covered operations has been completed; or (2) 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 C. The coverage provided hereunder shall be primary and non-contributing with any other insurance available to those designated above under any other third party liability policy All other terms and conditions remain the same. BW-EILPACK-0005A 01 -15 Page 1 of WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TherZenith® WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. 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 5.00% of the California workers compensation premium otherwise due on such remuneration. Minimum Premium: $0.00 Schedule Person or Organization CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA, CA 92253 RE: CA OPERATIONS 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 04/01/2020 ZENITH INSURANCE COMPANY - 13145 Insured SOUTHWEST AQUATICS Policy No. Z133313205 Policy Period 04/01/2020 To 04/01/2021 Issued On 03/27/2020 At Fresno, CA PRESIDEN WC-04-03-06B (Ed. 10-07) Endorsement No. 19