Loading...
Insurance Certificates 2020/22 Vintage Electric'►'+ CERTIFICATE OF LIABILITY INSURANCE 5/24/2021D/vvvY) 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 endorsements . PRODUCER Professional Insurance Associates PO Box 1266 San Carlos, CA 94070 CONTACT NAME: PHONE 909 337-9437 FAX A/C No:(909) 494-8338 E-MAIL bobohesslerinsurance.com ADDRESS: License#:OG30638 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Colony Insurance Comp INSURED Vintage Electric INSURERB: ICW Vintage E & S , Inc. INSURER C : Mercury Insurance 49950 Jefferson St. 130-388 INSURERD:Colony Insurance Comp Indio, CA 92201 INSURER E: INSURERF: 760 775-0135 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO 000 CLAIMS -MADE El OCCUR PREMISES Ea occurrence $ 100 000 MEDEXP (Anyoneperson) $ 5,000 A X 103GL0031522-01 9/27/209/27/21 PERSONAL &ADV INJURY $ 1,000,000 'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY E] PRO � LOC n PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ r r BODILY INJURY (Per person) $ C ANYAUTO X ALL OWNED SCHEDULED AUTOS AUTOS X BA 040000035434 8/14/208/14/21 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS P AUTOS D UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XS4247167 9/27/209/27/21 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ r r OUF DED I I RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N/'4 WPL 5053943 01 02/24/212 24 22 / / X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. rFRTIFIrOTF Hni nPP rANI(:FI I OTInN1 City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 78-495 Calle Tampico THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN La Quinta, CA 92253 ACCORDANCE WITH THE POLICY PROVISIONS. jmignogna@laquintaca.gov AUTHORIZED REPRESENTATIVE �7 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INSURED D I V I D E R P A G E Producer No: 0001655 SAN: 40967110000000 Pol Eff Dt: 02-24-2021 Office: 24 Date Printed: 05-24-2021 Time Printed: 08:18:14 Trans Eff Dt: 02-24-2021 Insured Name: VINTAGE E & S INC Policy No: WPL5053943 Trans Seq No: 002 Trans Type: Change Endorsement Oper Init: ALOPEZ- Company Abbr: IW Release Version: 21.01 User-Selected Sets Copies Printer INSURED COPY 01 PDF ONLY COMPANY COPY 01 PDF ONLY BUREAU COPY 01 PDF ONLY 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 01 02-24-21 001 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 8,216 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 01 02-24-2021 02-24-2022 05-24-21 INSURANCE COMPANY OF THE WEST 0001655 VINTAGE E & S INC PROFESSIONAL INSURANCE ASSOCIA CALIFORNIA - WAIVER OF SUBROGATION 1 5140 ELECTRICAL MAIN GENERAL ELECTRICAL $ 0 0.134 $ 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 01 02/24/2021 001 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 anyo ne 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 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