Insurance Certificates 2021/22 Acorn Technology ServicesA� d CERTIFICATE OF LIABILITY INSURANCE °"-'M °°" "'
3/29/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 INSURERS),AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holtler 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 center rights to the
certificate holder in lieu of such .ndwin ment(s),
vaooOCEn
Kellogg 6 Moreland Agency, Inc. DBA
Arroyo Insurance Service.
1654 Plum Lane
Redlanls CA 92374-4532
CORT
NANE.GT Julie Rybak
WI (909) 792-8950 uc Xe: Iron nz-xmxm
NOORRE6s: jolierilarroyoine.com
INSURER(S) AFFORDING COVERAGE
NAIL Y
INSURERA: Federal Ina Co
20281
INSURED
Mighty Oak Technology, DBA: Acorn Technology Be,!..
1960 Chicago Ave aE9
River.ide CA 92507
INSURENB:Allmeri°a Financial Benefit Insurance C
41840
INSURER C:
INSUREfl O:
MSURER E:
INSURER I.
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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CRANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE HAD RANCE 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
LTN
LIFE OF INSURANCE
ADDL
SUBR
ppLICYXUMBER
MW°ICY EFF
MNJ° ErP
LIMBS
X
CWLNBI OMMERCLGENERALIITY
EACH OCCURRENCE
S 1,000,000
A
CLAIMS -MADE X� OCCUR
PREMISES Eac
S Excluded
MEU E%P(A ne p,—n)
S 30,0°0
X
3593-35-68 arm
3/,I/ 0O 1
3/20/2022
PERSONAL BADV INJURY
$ 1,000,000
GENLAGGREGATELIMRAPIRUESPER:
GENERALAGGREGATE
$ 2,000,000
PRODUCTS-COMPIOPAGG
$ 2,000,000
POLICY PECL RO- ElLOO
J
$
OTHER'
AUTOMOBILE LIABILITY
CO .N0E01 IN L LI IT
§ 11000,000
SOOTY INJURY (Pe, perew)
S
A
ANYAUTO
ALL OWNED SCHEDULED
AUTOS Amos
X X NONAWNE°
HIRE°AIROS AUTOS
'1352-68-66
3/2D/ROR1
9/20/2022
ROCILV INJURY (Pa,ewtlenX
$
peOREP YT1AMAGE
$
S
X
UMBRELIAWB
X
OCCUR
EACH OCLURRENCE
S 2,000,000
AGGREGATE
$ 2,000,000
A
EXCESS LAB
CLAIMSMADE
RED RE _
'I983-21-bY- _
3/RO/20R1
$
3/20/202
WORRER6 at,no.
X PER
R
AN°EM R3'LABIIITY YINMBR
gXVP OFWETOIUPARTNFAIEXELUTIVE
EL EACH ACCIDENT
$ 1 000 000
EL DISEASE-ESEMPLOYEE
1000000
B
(Ma mm,1nNXP E%CLVOEn2 ❑
NIA
y
.3-p111236-02
l/I/R021
'I/1/2@2
EL DISEASE -POLICY LIMIT
1,000,000
Iry deemce "over
CE RIPTION OF OPENAnONS ONmv
L]2a 'eDility
3583-35-68 FTc
3/20/2021
3120/2022
W.ci m0rmrepab G,M
A
DESCRIPTIONOFWEM NSIWCAONSIVEHICLES(ACORD101,MdoonalR—Um ScMEulc, may Ym aWchedXmmIapace bmelind)
"City of Is Quints is hereby recognized as additional insured including primary wording per attached form
#8002236711
1FmTIF.I.TF uOU nFR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of La Quinta
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
78495 Calla Tampico
La Quinta, CA 92253
AUTHORIZED REPRE6ENTATVE
//
Julie Rybak/JULIE 0 T'
Ill AGO DCORr VRMI A/R. nX ,.,Iu I eav,vm,u.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS02512D1Nm)
` TM
Hanover
Insurance Croup_
W23 D961238 1001674
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 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 IN TA, CA 92253
This endorsement changes the policy to which it is allached 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. W23-0961238-02 Endorsement No.
Insured
Insurance CompanyALLMERICA FINANCIAL BENEFIT INSURANCE
Countersigned By
WC 04 03 06 (Ed 04-94)
ACC)R oe CERTIFICATE OF LIABILITY INSURANCE 3/29i21
THIS CERTIFICATE IS ISSUED ASA 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 Me 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 enciorsement(s).
PRODUCES
Kellogg 6 Moreland Agency, Inc. DDA
Arroyo Insurance Services
1654 Plum Lane
Redlands CA 92374-4532
NONE: Julie Eybak
Pxoxe (909)792-8950 FAK xo I.oevavmP
RWRESs: julier@arroyoins. com
INSURERS AFFORDING COVERAGE
MUSIC O
INSURERA: Federal Ina Co
20281
INSURED
Mighty Oak Technology, DENA: Acorn Technology Services
1960 Chicago Ave kE9
Eiverside CA 92507
INSURERS: Allmerica Financial Benefit Insurance C
41840
INSURER C:
IxwREa o:
INSURERS:
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. 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN3R
NEI
PIPE OF INSUMNOE
AUOL
VBR
POLICY NUMBER
IOMOOVYYFF
MMIXIICDY�y
LIMITS
X
COMMERCNLGENERALURSHURY
EACH OCCURRENCE
S 1,000,000
A
CLAIMS -MADE Fx-1OCWR
PREMISES Ee oITED
___
$ Excluded
MED EXP (Pny 01D Pnnon)
$ 1D,000
X
3503-35-68 w6
3/2012021
3/20/2022
PERSONAL aADV INJURY
$ 1, 000, D00
GEN'LAGGREGNTE LIMITAPPLIES PER
GENERALAGGREGATE
S 2,0001000
PRODUCTS-COMPA)PAGG
$ 2,000,000
POLICY PIER El LCC
JECi
a
OTNER.
AOTOMODILELWEIpTY
COMBINED SINGLE LIMIT
i,000,000
$R$2
BODILY INJURY (Per pamon)
ANY AUTO
A
BODILY INJURY (Per aaJOml)
ALL OWNED SCNEDULED
T352-60-66
3/20/2021
3/20@@2
AUTOS AUTOG
X X NONOWNEO
pBOPERIV 04MAGE
IREOAUTOS AUTOS
UMRREUALMB
X
-CUR
EACH OCCURRENCE
00 OODAEVIESS
AGGREGATE
00 000ION
UAM
CLAIMS -MADE
S
1003-2l-01
3/20/2021
31N/2022
WORNESS COMPENSAnIXIANDEMPLOYERe'LABWPI
Y
CUTNE
EACH ACCIDENT
00 000
EL DISEASE-EAEMPLOVEE
f 1000000
H
OFFICER,MEMBERRANTINEXCLUDFD9
IManOtlory Ln XM)
xlAEL
y
R2311623.-.i
7/1/2020
1/1/2031
EL. DISEASE - POLICY LIMIT
$ 1,000,000
Nye., d... It. .,dw
DESCRIPTIONOFOPERATIONG W&
Cybec Liability
3EES-35-la VICE
3/20/2021
3/20/2022
WJSoGMAgeW-Lmn
A
DESORIPnIXIOFOPEIGTMNSILOCATIONS/VEHICLESIACORD101,AddftlanalWme a6tR.durgmey MaW.MdOmanapnle"ulndl
"City of La Quints, is hereby recognised as additional insured including primary wording per attached form
#80022367"
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of La Quints THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
78495 Call. Tampico
La Quints, CA 92253
AUnI(XLIZED REPRFFExrAnvE
Julie Rybak/JULIE 49
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 DOWN)
4fk.� o® CERTIFICATE OF LIABILITY INSURANCE °A3/z92002
THIS CERTIFICATE IS ISSUED AS 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(les) 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).
Pa00ucER
Kellogg a Moreland Agency, Inc. DBA
ALIOYO Insurance 8eN1Ce9
1654 Pl= Lane
Redlands CA 92374-4532
N ME: Julia Aybak
PxONE (909)792-8950 FA Nn. ......
ADDRESS: Julier@arrOoins.000
INSURERB AFFORDING COVERAGE
NAICO
INSURERA: Federal Ina Co
20281
INSURED
Mighty Oak Technology, DBI; Acorn TechnolOgy ServiceS
1960 Chicago Ave NE9
RiVar9ide CA 92507
INSBRERB: A110eriCa Financial BeRe£it Insurance (
41840
INSURER C:
INSURER D:
INSURER E:
INSURER F:
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, NOIVATHETANDINGANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN9R
R
rypE 61NSURANCE
ME
pOLICYHUMBER
es.. EFT
^OLJCYERP
nM113
%
COMMERCIAL GENEMLLABILItt
EACH OCCURRENCE
E 11000,000
A
CLAIMS -MADE OCCUR
_°
PREMI
f Excluded
MEO EXP IAnyOrc PonOn)
f 10,000
X
3583-35-68 NCE
3/20/3021
3/20/3022
PERSONAL SAW INJURY
$ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER'.
GENERALAGGIREGATE
$ 2,000,000
PRODUCTS-COMPNPAGG
$ 2,000,000
PoLICY PRO ❑ LCC
JECT
E
OTXEL
AVTOMO&LE LIABILIry
COMBINED SINGLE IN ELIMIT
E 1,000,000
BODILY INJURY RmOU
$
A
ANYAUTO
ALL MANED SCHEDULED
AUI05 ACTIONNON-0WNEO
X HIREDAIROS 'Y AUTOS
Y352-68-11
3/20/2021
3/20/2022
BODILY INJURY IPotlenR
S
PROPERTY DAMAGE
Pe�ecc4enl
g
B
X
UMBRELLALMB
X
OCCUR
EACX OCCURRENCE
S 2 000 000
AGGREG4TE
f 2 000 000
A
E%CE9S LIAR
CLAIMBBMADE
CEO
RETENTIONS
g
7983-27-01
3/20/2021
3/20/2022
NORRERSCCMPENSATION
ANOEMPLOYERS'LAIDURY
ANY PROPRIEPGURARTNERi ECUTIVE Y❑NIA
X PER X-
BTAT ER
EL EACH ACCIDENT
8 1,000,000
EL DISEASEEAEMPLOYEE
IS 1,000,000
B
Re r,uaroiylin NX E%CWOE09
y
p2y_pg61238-01
1/1/2020
T/1/2021
EL DISEASE POLICY LIMIT
S 1,000,000
T yee OO;Owe untlx
OESCRIWIONOFOPERAPONSIM1.
OESCRIP WOFOPE ONSILOCATDNS;VEHICLES(ACOROIBI,A Himal RemnlSLM4ule,mYMaWcMN m.n mlenqulmdI
"City of Ie Quinta is hereby recognised as additional insured including primary wording per attached form
X8002236T"
City of La Quints
78495 Calle Tampico
La Quints, 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.
Rybak/JULIE
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 DRJUR
CH U BB' Liability Insurance
Endorsement
Policy Period
MARCH 20, 2021 TO MARCH 20, 2022
Eflectow Date
MARCH 20, 2021
Policy Number
3583-35-68 VICE
Insured
MIGHTY OAR TECHNOLOGY DBA ACORN
TECHNOLOGY SERVICES
Name of Company
FEDERAL INSURANCE COMPANY
Date Issued
DECEMBER 21. 2020
This Endorsement applies to the following forms:
GENERAL LIABHdIY
Under Who Is An Insured, the following provision is added
Who Is An Insured
Additional Insured- Penance or organizations shown in the Schedule are Insureds; but they are insureds only if you are
Scheduled Person obligated pursuant m a contract or agceraent to provide them with such insurance as is afforded by
Or Organization sus pommy.
However, the person or organization is an Insured only:
• if and then only in the extrut the person or organization ie described in the Schedule;
• to the extent such contractor agreement requires the person or organization to be afforded
states as 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 a 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 any other provision of the Who is An Insured
section (regardless of my limitation applicable thereto).
• with respect to my assumption of 0ability (of mother person or orgattention) by them in
contract or agreement Ibis Umberto dues not apply to the liability for damages, loss, cast or
expense for injury or damage, to which this insurance applies, thm the person or ogmization
would have in the absence of such contract or agreement.
Usually Insurance Addddmrel8wura0- Sd"Wed Person 0`01901tembn cnnanued
Form 80e2.28ar fRov. 5-07) Er Ma ffl Pao r
CHUBB°
UabAity Endorsement
(continued)
Under Conditions, the following prevision is added to the condition dried Other Insurance.
Conditions
Other Insurance- It you are obligated, pmsuaot to a contract or agreement, to provide the person or organization
Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then to such case
Insurance -Scheduled this insurance is primary, and we will act seek contribution from insurance availahle to such person
Person Or Organization or organization.
Schedule
CITY OF LA QUANTA
78495 CALLE TAMPICO LA QUATA, CA 92253
All other tams and conditions remain unchanged.
AuMMzednePrmunua w Q-0s'",
Washy Insurance Addi6'ww1 hwursd- SdwdWed Pwson Oi 019wn bbn awtp
Porn e0—oa 57(aev. 5L7) EadorswrwM Pegs 2
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)