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Insurance Certificates 2020/21 Vintage ElectricANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) CERTIFICATE OF LIABILITY INSURANCE Vintage Electric Vintage E & S, Inc. 10/20/2020 Professional Insurance Associates PO Box 1266 San Carlos, CA 94070 License#:0G30638 (909) 337-9437 (909) 494-8338 bob@hesslerinsurance.com Vintage Electric Vintage E & S, Inc. 49950 Jefferson St. 130-388 Indio, CA 92201 (760)775-0135 Colony Insurance Comp ICW Mercury Insurance Colony Insurance Comp A X X X 103GL0031522-01 9/27/20 9/27/21 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 C X X X BA 040000035434 8/14/20 8/14/21 1,000,000 D X X XS4247167 9/27/20 9/27/21 5,000,000 5,000,000 B N WPL 5053943 00 2/24/20 2/24/21 X 1,000,000 1,000,000 1,000,000 Certificate Holder is named Additional Insured as their interest may appear pursuant to written agreement. Blanket Additional Insured applies. This insurance is Primary and Non-Contributory. Waiver of subrogation applies to Workers Compensation. City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 jmignogna@laquintaca.gov Vintage Electric ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01) CERTIFICATE OF LIABILITY INSURANCE Colony Insurance Comp 8/31/2020 Professional Insurance Associates PO Box 1266 San Carlos, CA 94070 License#:0G30638 (909) 337-9437 (909) 494-8338 bob@hesslerinsurance.com Vintage Electric Vintage E & S, Inc. 49950 Jefferson St. 130-388 Indio, CA 92201 (760)775-0135 Colony Insurance Comp ICW Mercury Insurance Colony Insurance Comp A X X X 103GL0031522-00 9/27/19 9/27/20 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 C X X X BA 040000035434 8/14/20 8/14/21 1,000,000 D X X XS4247167 9/27/19 9/27/20 5,000,000 5,000,000 B N WPL 5053943 00 2/24/20 2/24/21 X 1,000,000 1,000,000 1,000,000 Certificate Holder is named Additional Insured as their interest may appear pursuant to written agreement. Blanket Additional Insured applies. This insurance is Primary and Non-Contributory. Waiver of subrogation applies to Workers Compensation. City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 jmignogna@laquintaca.gov Colony Insurance Comp COMMON POLICY DECLARATIONS COLONY INSURANCE COMPANY POLICY NUMBER: 600 GL 0031522-01 8720 STONY POINT PARKWAY, SUITE 400 RICHMOND, VA 23235 RENEWAL OF: 103 GL 0031522-00 1. NAMED INSURED AND MAILING ADDRESS: Vintage Electric 49950 Jefferson St, 130 388 Indio, CA 92201 Operating Unit: General Casualty PRODUCER: 0010190 CRC Insurance Services, Inc. - CA, Redondo Beach 1815 Via EI Prado Riviera Center Redondo Beach, CA 90277 2. POLICY PERIOD: From 09127/2.020 to 09/27/2021 12:01 A.M. Standard Time at your Mailing Address above. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL OF THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. 3. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. COVERAGE PARTS Commercial General Liability Coverage Form Premium charge for coverage of certified acts of terrorism: (Per Terrorism Policyholder Disclosure attached.) or Coverage for certified acts of terrorism has been rejected; exclusion attached. (Per Terrorism Policyholder Disclosure attached.) Premium shown is payable at inception Total Policy Premium: Inspection Fee: Policy Fee: 4. FORMS APPLICABLE TO ALL COVERAGES: See Form 0001 — Schedule of Forms and Endorsements 5. BUSINESS DESCRIPTION: General contractor Countersigned: Date State Tax: $242.55 Stamping Fee: $20.21 By: /1 Authorized representative $0.00 $0.00 DCJ6550 (01/17) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: 600 GL 0031522-01 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: 600 GL 0031522-01 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 6YN;1_21111144 Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations as required by written As designated in written contract with the Named Insured contract with the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by ,.your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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: 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations as requested by written contract with the Named Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 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. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 INSURED The following item(s) Insured’s Name (WC 89 06 01) Item 3.B. Limits (WC 89 06 12) Policy Number (WC 89 06 02) Item 3.C. States (WC 89 06 13) Effective Date (WC 89 06 03) Item 3.D. Endorsement Numbers (WC 89 06 14) Expiration Date (WC 89 06 04) Item 4. *Class, Rate, Other (WC 89 04 15) Insured’s Mailing Address (WC 89 06 05) Interim Adjustment of Premium (WC 89 04 16) Experience Modification (WC 89 04 06) Carrier Servicing Office (WC 89 06 17) Producer’s Name (WC 89 06 07) Interstate/Intrastate Risk I.D. Number (WC 89 06 18) Change in Workplace of Insured (WC 89 06 08) Carrier Number (WC 89 06 19) Insured’s Legal Status (WC 89 06 10) Issuing Agency/Producer Office Address (WC 89 06 25) Item 3.A. States (WC 89 06 11) X X POLICY INFORMATION PAGE ENDORSEMENT 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. Endorsement No. Insured Premium: Insurance Company Countersigned By SEE ATTACHED WC 99 06 54 (03-08) EXTENSION WPL 5053943 00 02-24-20 003 INSURANCE COMPANY OF THE WEST WAIVED UNTIL AUDIT VINTAGE E & S INC THE POLICY IS AMENDED AS FOLLOWS: AMENDED POLICY TO ADD WAIVER OF SUBROGATION FOR: CITY OF LA QUINTA 78-495 CALLE TAMPICO LA QUINTA, CA 92253 GENERAL ELETRICAL MAINTENANCE 500 11,627 INSURED WC 00 00 01A Page 1 (Ed. 6-16) Issue Date: PO Box 509039 San Diego, CA 92150-9039 Standard Workers’ Compensation and Employers’ Liability Policy Named Insured: Policy Number: Agent Name: Policy Period: To Agent No: Schedule: Waiver No. Class Job No. Job Description Payroll Rate Premium WPL 5053943 00 02-24-2020 02-24-2021 08-26-20 INSURANCE COMPANY OF THE WEST 0001655 VINTAGE E & S INC PROFESSIONAL INSURANCE ASSOCIA CALIFORNIA - WAIVER OF SUBROGATION 1 5140 ELECTRICAL MAIN GENERAL ELECTRICAL $ 0 0.1495 $ 0.00 MAINTENANCE 1 To Equal Minimum Premium $ 50.00 CALIFORNIA - Waiver of Subrogation Total $ 50.00 Page 1 INSURED 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. Endorsement No. Insured Premium $ Insurance Company Countersigned By WPL 5053943 00 02/24/2020 003 INSURANCE COMPANY OF THE WEST VINTAGE E & S INC INCL. WC 99 06 37 (Ed. 5-02) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 37 (Ed. 5-02) 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 % of the California Workers’ Compensation premium otherwise due on such remuneration, subject to a minimum premium of . Schedule Person or Organization Job Description CITY OF LA QUINTA ELECTRICAL MAINTENANCE 5 $ 50 78-495 CALLE TAMPICO CITY LIMITS OF LA QUINTA LA QUINTA, CA 92253 GENERAL ELECTRICAL MAINTENANCE