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Insurance Certificates 2021/22 Ocean Springs TechANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD 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 RENTEDCLAIMS-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 AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (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 LIMITDESCRIPTION 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 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 4/13/2021 License # 0757776 (800) 366-7050 (925) 905-5584 26620 Independent Pool and Spa Service Association Ocean Springs Tech, inc. PO Box 3367 Rocklin, CA 95677 A 1,000,000 X X AXRPG1100001-00 4/1/2021 4/1/2022 200,000 5,000 1,000,000 3,000,000 3,000,000 Swimming Pool Service, Repair and Remodeling Covered Member: Armando Rodriguez of Ocean Springs Tech, Inc. Certificate holder is listed as additional insured per form AXIS 101 2827 0221 Primary and no contributory per form attached. Waiver of subrogation applies. City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 OCEASPR-02 EAGUINA San Ramon, CA - HUB International Insurance Services Inc. 2300 Clayton Rd Concord, CA 94520 Lin Estrada nan.win@hubinternational.com Axis Surplus Insurance Company X X X OCEASPR-02 SGONZAL CERTIFICATE OF LIABILITY INSURANCE DATE4/8/2 D/YYYY) l8/2021 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0767776 NRA�AbT Rocky Stein HUB International Insurance Services Inc. PHONE FAT[ 272 (AJC, No, Ext): (925) 415-5152 (A;C, No):(951) 231.. 3000 Executive Parkway .. Suite 300 EMAIL cal.0 u hubinternational.com ADDRESS: p San Ramon, CA 94583 INSURER(S) AFFORDING COVERAGE NAIC INSURER A:Nationwi-de_Mutual Insurance Company 23787 INSURED INSURER B:Insurance Company Of the West _ 27847 Ocean Springs Tech, Inc. INSURER C : P.O. Box 234 INSURER D : Desert Hot Springs, CA 92240 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I 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. INSR ADDL:SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IN D WVD POLICY NUMBER p/yyyy LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 5 -MED EXP (Any one person) PERSONAL & ADV INJURY GEWL AGGRE-GA I E LIMIT APPLIES PER: GENERAL AGGREGATE �t POLICY PRO- JECT LOC PRoouJ $ - COMPIDP AGG I t A COMBINED SINGLE LIMIT 1 000 0 AUTOMOBILE LIABILITY AEa.aWdenl). $ X ACP3097672992 4/1/2021 4/1/2022 ANY AUTO BODILY INJURY_(Perpersgn) $ _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X Hlpp��pp X NON -OWNED PROPERTY DAMAGE AU1MOS ONLY AUTOS ONLY _(Per accident) $ _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS -MADE AGGREGATE$ _ DED RETENTION $ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE. : ER _ YIN 'WPL503357105 4/1/2021 4/1/2022 1,000,000 AANNY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? N N / A E.L. EACH ACCIDENT . $ In NHj 1'ooO,00a (Mandatory E.L. DISEASE -EA EMPLOYEE_ $_ If yes, describe under 1,�t)�,00� _DESCRIPTJO"EOPERATIONS below I F_L. OI SEASE - POLL CY LIMIT $ I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) For Information Purposes Only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. 78.495 Calle Tampico Palm Springs, CA 92263 AUTHORIZED REPRESENTATIVE 04,�• Z_ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OCEASPR-02 SGONZAL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D21�) 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 License # 0757776 CONTACT Rocky Stein NAME., HUB International Insurance Services Inc. PHONE 3000 Executive Parkway I�uc, Nc, E><t}; (925j 415-5152 (arc, No}:(S51 j 231-2572 Suite 300 E- oAIL . cal.cpu@hubinternational.com San Ramon, CA 94583 INSURERS) AFFORDING COVERAGE NAIL # INRIIRFRo,Nationwide Mutual Insurance COmoanv 123787 INSURED Ocean Springs Tech, Inc. P.O. Box 234 Desert Hot Springs, CA 92240 COVERAGES CERTIFICATE NUMBER: INSURER C : Ins INSURER E. INSURER F : rs Insurance 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLMMJICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY ❑ OCCUR EACH OCCURRENCE $ DAMA 9ETO RENTED PREMCLAIMS-MADE $ MED EXP (Any oneperson) $ PERSONAL 3ADV INJURY $ G£N'L AGGREGATE LIMITAPPLIES PER: POLICY PRO- n LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X A�TOS S ACP3097672992 4/1/2021 4/1/2022 COMBINEED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) S BODILY INJURY Per accident $ P OPEER r AMAGE $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AN1237430 4/1/2021 4/1/2022 EACH OCCURRENCE $ 4,000,000 AGGREGATE S DED I X I RETENTION $ 10,000 Prod/Comp Ops $ 4,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X WpL503357105 4/1/2021 4/1/2022 X !PER I I OTH- STATUTE I ER E.L E4C14ACCIDENT $ 1'000'000 E.L. DISEASE - EA EMPLOYEE1 $ 1,000,000 E.L. DISEASE-POLICYIaMJT 1 00� 000 $ ' ' DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required} Waiver of Subrogation with regard to Workers Compensation applies in favor of City of La Quinta when required by written contract per the attached endorsement form WC990634 08/00. City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0Aala"z_. ACORD 25 (2016103) ©1988-;�015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:AXRPG1100001-00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 24 04 05 09 © Insurance Services Office, Inc., 1992 Page 1 of 1 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: City of La Quinta 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. AXIS 101 2827 0221 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 Endorsement Number Effective Date of Endorsement Policy Number Premium 1 12:01 a.m. on 4-1-2021 AXRPG1100001-00 Incl. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that: A.Section II - Who Is An Insured is amended to include as an additional insured: 1.Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2.Any other person or organization you are required to add as an additional insured under the contract or agree- ment described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to loss or damage arising from: 1."Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a.The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2."Bodily injury" or "property damage" occurring after: AXIS 101 2827 0221 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 a.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 b.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.With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph A.1.; 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. All other provisions of the Policy remain unchanged. POLICY NUMBER:AXRPG1100001-00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 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. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL 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 04/01/2021 Policy No. WPL 5033571 05 Endorsement No. Insured OCEAN SPRINGS TECH INC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED