Loading...
Insurance Certificates 2021/22 Convergint Technologies, LLCPage 1 of 2 DATE (MM/DDIYYYY) ,4coo CERTIFICATE OF LIABILITY INSURANCE F02/22/2021 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willie Towers Watson Nidwast, Inc. -p`HE c/o 26 Century Blvd 1-877-945-7376 AIC N°. 1-888-467-2378 P.O. Sox 305191 E-MAIL certificates@willis.nom Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAICIf INSURERA: XL Insurance America Inc 24554 INSURED INSURERS: Federal Insurance Company 20281 Convergint Technologies LLC #601 Location Y601 INSURERC: XL specialty Insurance Company 37885 Onn Commeres Drive INSU4ERD: Indian Harbor Insurance Company 36940 Schaumburg, IL 60173-- COVERAGES CERTIFICATE NUMBER: W20112085 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, KS-R.TYPE OF INSURANCE A []L ' — - ~ — POLICY EFF POLLCY EXP LTR POLICY NUMBER [IAMeDD.'YYY MM0 Y J LIMITS X I COMMERCIAL GENERAL LIABILITY �EACHOCCUFIRENCE $ 1,000, 000 _ CLAIMS -MADE OCCUR PREMISES Eapca;rrQG91;)_ _$ 300,000 A MED EXP (Any One person) $ 10,000 Y CGS 7409054 09 03/01/2021 D3/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE L$ 2,000,000 POLICY 1, XJE� 7 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ 17THER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 Ea acclden $ 1, 000, 000 BODILY INJURY (Per person) _ $ X ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CAD 7459994 103/01/2021 03/01/2022 BODILY INJURY (Per accidenl)' $ PROPERTYDAMA(DE H X UMBRELLA LIAB X I OCCUR EXCEjSSLIA13 CLAIMS -MADE `` $365-2578 iO3/01/2021�03/01/2022 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE - $ 10,000,000 DED tl 11LW10NS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE Y+ N OFFICERIMEMBEREXCLUDED? No NIA (Mandatory In NH) Y C19D 7459993 03/01/2021 03/01/2022 X STATUT FA E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ L,000,000 $ L,000,000 II yes, dEscribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liability CEo744682205 03/01/2021 03/01/2022 Each Claim $2,000,000 Aggregate $2,000,000 Retention $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Workers Compensation and Employers Liability (WI) Policy #CWR 7459998 Applies Per Statute Insurance Carrier: XL Specialty Insurance Company NAIC N 37885 Policy Term: 03/01/2021 - 03/01/2022 SEE ATTACHED k;I;h I It-IL:AI L NULL)L:H CANL:LLLA I iUN City of La Quints 78495 Calls 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. AUTHORIZED REPRESENTATIVE 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 20736390 sATcao 1994287 2 of 5 7796 ACaR�D' AGENCY Willis Towers Watson Midwest, Inc. POLICY NUMBER see Page 1 CARRIER See Page 1 ADDITIONAL REMARKS AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE NAMED INSURED Convergint Technologies LLC #60:1 Location 6601 One Commrcn Drive Schaumburg, IL 60173 NAIC CODE See Page 1 I EFFECTIVE DATE: See Page 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER• 25 FORM TITLE• Certificate of Liability insurance E.L. EACH ACCIDENT: $1,000,000 E.L. DISEASE - EACH EMPLOYEE: $1,000,000 E.L. DISEASE - POLICY LIMIT: $1,000,000 Page 2 of 2 Job Project Location: Public Safety Camera System (PSCS) 601SNO8045 - City of La Quinta Citywide Surveillance City of La Quinta and its officers and its employees are included a� Additional Insureds as respects to General Liability, as required by written contract. It is further agreed that such insurance as is afforded shall be Primary and Non -Contributory as respects to General Liability with any other insurance in force for or which may be purchased by Additional Insureds as required by wri`toa contract. A Waiver of Subrogation in favor of Additional Insureds applies to the Workers Compensation where required by written contract as permitted by law. INSURER AFFORDING COVERAGE: Indian Harbor Insurance Company NAICII: 36940 POLICY NUMBER: MTP9030905 07 EFF DATE: 03/01/2021 EXP DATE: 03/Dl/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Cyber Aggregate $5,000,000 Occurrence $5,000,000 Retention $100,000 ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20736390 BATCH: 1994287 CERT: W20112085 POLICY NUMBER: CGS 7409054 09 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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(!) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION THAT YOU ARE VARIOUS AS REQUIRED PER WRITTEN REQUIRED IN A WRITTEN CONTRACT OR WRITTEN CONTRACT. AGREEMENT TO INCLUDE AS AN ADDITIONAL INSURED PROVIDED THE 'BODILY INJURY' OR "PROPERTY DAMAGE" OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. 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", "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. B. 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. CG20101219 © Insurance Services Office, Inc., 2018 Page 1 3 of 5 7796 C. With respect to the insurance afforded to these 1. Required by the contract or agreement; or additional .insureds, the following is: added to 2. Available Under the applicable limits of Section III — Limits Of Insurance: insurance; If coverage provided to the additional insured is whichever is less. required by, a contract or agreement, the most we will pay on behalf of the additional insured is the This endorsement shall not increase the applicable amount of insurance: limits of insurance. CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 2 POLICY NUMBER:CGS 7409054 09 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION THAT YOU ARE VARIOUS AS REQUIRED PER WRITTEN REQUIRED IN A WRITTEN CONTRACT OR CONTRACT. WRITTEN AGREEMENT TO INCLUDE AS AN ADDITIONAL INSURED PROVIDED THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG20371219 © Insurance Services Office, Inc., 2018 Page 1 4 of 5 7796 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN AGREEMENT SIGNED PRIOR TO LOSS. 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 March 1, 2021 Policy No. CWD 7459993 Countersigned by WC000313 (Ed. 4-84) 0 1983 National Council on Compensation Insurance. ENDORSEMENT This endorsement, effective 12:01 a.m., March 1, 2021, forms a part of Policy No. CGS7409054 09 issued to CONVERGINT TECHNOLOGIES, LLC by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 ©, 2005, XL America, Inc. 5 of 5 7796 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Convergint Technologies LLC #601 Location #601 One Commerce Drive Schaumburg, IL 60173 Workers Compensation and Employers Liability (WI) Policy #CWR 7459998 Applies Per Statute Insurance Carrier: XL Specialty Insurance Company NAIC # 37885 Policy Term: 03/01/2021 - 03/01/2022 E.L. EACH ACCIDENT: $1,000,000 E.L. DISEASE - EACH EMPLOYEE: $1,000,000 City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 02/26/2021 1-877-945-7378 1-888-467-2378 certificates@willis.com XL Insurance America Inc 24554 Federal Insurance Company XL Specialty Insurance Company 20281 37885 W20196420 A 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 Y Y CGS 7409054 09 03/01/2021 03/01/2022 A 1,000,000 03/01/202203/01/2021YYCAD 7459994 B 10,000,000 Y Y 9365-2578 03/01/2021 03/01/2022 10,000,000 CWD 7459993CY 1,000,000No03/01/2021 03/01/2022 1,000,000 1,000,000 200201420777828SR ID:BATCH: Willis Towers Watson Certificate Center Page 1 of 2 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Convergint Technologies LLC #601 Location #601 One Commerce Drive Schaumburg, IL 60173 E.L. DISEASE - POLICY LIMIT: $1,000,000 Job Project Location: 601SNL7114, Citywide Public Safety Camera System, Project No. 2020-03 The City of La Quinta and its officers and employees are included as Additional Insureds as respects to General Liability and Auto Liability as required by written contract. It is further agreed that such insurance as is afforded shall be Primary and Non-Contributory as respects to General Liability, Auto Liability and Umbrella/Excess Liability with any other insurance in force for or which may be purchased by Additional Insureds as required by written contract. A Waiver of Subrogation in favor of Additional Insureds applies to the General Liability, Auto Liability and Workers Compensation policies where required by written contract as permitted by law. Umbrella/Excess Follows Form on Additional Insureds. Waiver of Subrogation status on Excess Follows General Liability and Auto Liability Form. 2 2 Willis Towers Watson Midwest, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W20196420CERT:2002014BATCH:20777828SR ID: 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN AGREEMENT SIGNED PRIOR TO LOSS. Countersigned by __________________________________________ WC 00 03 13 (Ed. 4-84) Endorsement Effective (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. March 1, 2021 Policy No. CWD 7459993