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Insurance Certificates 2021/22 Southwest Aquatics.�Cal2D� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/24/2021 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 Lynn Holm NAME: y RISI dba Pan American Insurance Services PA(760) 772-1775 HCNN(760) 772-1700 me o Ext : No : 79-440 Corporate Center Drive E-MAIL lynn holm@relationinsurance.com ADDRESS: Suite 114 INSURER(S) AFFORDING COVERAGE NAIC # La Quinta CA 92253 INSURERA: Certain Underwriters at Lloyds INSURED INSURER B : Infinity Select Insurance Company 20260 Desert Limnologists, Inc., DBA: Southwest Aquatics INSURERC: Zenith Insurance Company 13269 PO Box 13212 INSURER D : Platte River Ins Co 18619 INSURER E : Palm Desert CA 92255 INSURER F : COVERAGES CERTIFICATE NUMBER: 2021 WC/PKG/Auto 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADVIL INSD SU13R WVD POLICY NUMBER POLICY EFF MM/DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE Fx_] OCCUR PREMISES Ea occ+xrence $ 100.000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV I NJURY s 2,000,000 A EC00556170R5 09/01/2021 09/01/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY 0 JECI' LOC PRODUCTS - COMP/OP AGG $ 4,000,000 Pollution Liability $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 504610143537001 09/01/2021 09/01/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE [Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY rx Uninsured motorist $ 1,000,000 UMBRELLA LIAR OCCUR EACH OCOURRENCE . $ AGGREGATE s EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? FYI (Mandatory in NH) N/A Z133313206 04/01/2021 04/01/2022 X1 S ATUTE EORH E.LEACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1,000,000 CSLB Bond D 41047527 02/12/2021 02/12/2023 Limit $15,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is listed as an Additional Insured and coverage is Primary & Non -Contributory, per form BW-EILPACK-0005A, as related to General Liability. Waiver of Subrogation applies per form WC-04-03-06B as respects to workers' compensation. CERTIFICATE HOLDER CANCELLATION The City of La Quinta 78495 Calle Tampico La Quinta 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT -OWNERS, LESSEES OR CONTRACTORS (PRIMARYAND NON-CONTRIBUTORY) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organisation Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For the purposes of this endorsement, Section II. WHO IS AN INSURED is amended to include as an insured the person or organization shown in the SCHEDULE above, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insuredb, the following paragraph is added to Section I COVERAGES Paragraph 2. EXCLUSIONS: 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 site of the covered operations has been completed; or (2) That portion of your workout 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. The coverage provided hereunder shall be primary and non-contributing with any other insurance available to those designated above under any other third party liability policy All other terms and conditions remain the same. BW-EILPACK-0005A 01 -15 Page 1 of WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TherZenith® 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. 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 5.00% of the California workers compensation premium otherwise due on such remuneration. Minimum Premium: $0.00 Schedule Person or Organization City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 RE: 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 ZENITH INSURANCE COMPANY - 13145 Insured SOUTHWEST AQUATICS Policy No. Z133313206 Policy Period 04/01/2021 To 04/01/2022 Issued On 03/30/2021 At Fresno, CA PRESIDEN WC-04-03-06B (Ed. 10-07) Endorsement No. 16