Insurance Certificates 2020/21 Nichols ConsultingINSURANCE REVIEW
RE:
Please list the Contracting Party / Vendor Name, type of agreement to be executed, including any change orders or
amendments, and the type of services to be provided. Make sure to list any related Project No. and Project Name.
Insurance certificates required per the Agreement:
ACCORD Certificate dated 10-days prior or less _____________________________
enter ACCORD issue date
Commercial General Liability Insurance:
$1,000,000 per occurrence/$2,000,000 aggregate OR
$2,000,000 per occurrence/$4,000,000 aggregate
Additional Insured Endorsement naming City of La Quinta
Primary and Non-Contributory Endorsement
Automobile Liability:
$1,000,000 combined single limit for bodily injury and property damage.
Workers’ Compensation:
Statutory Limits / Employer’s Liability $1,000,000 per accident or disease
Workers’ Compensation Endorsement with Waiver of Subrogation
Sole Proprietor
Professional Liability (Errors and Omissions):
Errors and Omissions Liability insurance with a limit of not less than
$1,000,000 per claim
Cyber Liability/Technology Errors and Omissions Liability Insurance:
$1,000,000 per occurrence/loss
Other: ________________________________________________________
List other insurance types such as – molestation, harassment, etc.
Approved by: ________________________
Date: ________________________
11/23/2020
Monika Radeva
January 21, 2021
FE-6609 Printed in U.S.A.
R3Y0 Policy No.: 90-CJ-W945-5
SECTION II ADDITIONAL INSURED ENDORSEMENT
Policy No.: 90-CJ-W945-5
Named Insured: Andy Nichols DBA Nichols Consulting
Additional Insured (include address):
City of La Quinta
78495 Calle Tampico
La Quinta, CA 92253
WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as
an insured the Additional Insured shown above, but only to the extent that liability is imposed on that
Additional Insured solely because of your work performed for that Additional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a
suit brought for damages for which you are provided coverage.
The Primary Insurance coverage below applies only when there is an "X" in the box.
Primary Insurance. The insurance provided to the Additional Insured shown above shall be
primary insurance. Any insurance carried by the Additional Insured shall be noncontributory
with respect to coverage provided to you.
All other policy provisions apply.
FE-6609