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Insurance Certificates 2021/22 SCOPE Eventsnr DATE (MM/DD/YYYY) ACORE> CERTIFICATE OF LIABILITY INSURANCE 11 /9/2021 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 Gaspar Insurance Services, Inc PHONE FAx 23161 Ventura Blvd, Suite 100 (A/C, No, Ext 818-302-3060 (A/C, No): Woodland Hills CA 91364 EMAIL DokEss;_ Licen§g#D 6626 INSURED SCOPEVE-01 Scope Events LLC 7049 Redwood Blvd Suite 201 C Novato CA 94947 INSURER(S) AFFORDING COVERAGE _ INSURERA: PHILADELPHIA INDEMNITY INSURAN NAIC# 18058 38342 INSURER B : California Automobile Insuranc INSURER C: Landmark American Insurance Co 33138 INSURER D - INSURER E ; INSURER F.- COVERAGES CERTIFICATE NUMBER:349198645 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. MR' TSu�t� POLICY EFF POLICY E]IP LTR TYPE OF INSURANCE = POLICYNUMBER MMIDD7YYYY MIWD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PHPK2311444 10/8/2021 1 10/8/2022 EACH OCCURRENCE $ 1,000.000 �:p CLAIMS -MADE E OCCUR EMt5ES �Ea 000u1 c�et S 100,000 MED EXP (My one $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY EC LOC GENERAL AGGREGATE $ 2,000.000 PRODUCTS - COMP/OP AGG S 2,00D.000 $ OTHER B AUTO MOBILELIABILITY ANY AUTO Y Y BA040D00055197 10/14/2021 10/14/2022 MBINED NGLELIMIT nesle t $1,000,000 BODILY INJURY (Per person) S OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident ) $ X HIRED X NON -OWNED AUTOS ONLYJ AUTOS ONLY PROPERTY DAMAGE accldenk $ + I $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS ,VADE AGGREGATE $ S ::i�i: I RETENTIONS f WORKERS COMPENSATION PER O W AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A STATUTE E E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ (Mandatory in NH) ss IfYes. under EL DISEASE - POUCYLIMIT $ DESCRIPTION RIPTION OF OPERATIONS below C PROFESSIONAL LIABILITY LHR84200 3/1/2021 3/1/2022 EACH CLAIM LIMIT $ 1.000.000 AGGREGATE LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta is included as additional insured if required by written contract Please refer to the attached endorsements. laFf I Ir0.:A I t MULDEK CANCELLATION 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 Rr.PRESENTATiVE PC ©1988-2015 ACORD CORPORATION. All rights reserved- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK2311444 Additional Insured City of La Quinta 78495 Calle Tampico La Quints, CA 92253-2839 CG2026 - General Liability Page 1 of POLICY NUMBER: PHPK2311444 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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): City of La Quinta 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: 10/08/2019 Name of Person or Organization (Additional Insured): City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Declaration Regarding California Workers' Compensation You are required to complete this form because you have not filed a certificate regarding workers' compensation insurance with City of La Quinta. California law requires all employers to carry workers' compensation insurance, even if they have only one employee. If you do not know whether you are required to carry workers' compensation insurance, find out by contacting the California Department of Industrial Relations ("DIR"). Information is also available on the DIR's website at http://www.dir.ca.gov. You should also consult with your attorney, insurance agent or broker, or carrier regarding the specifics of your situation and your options. If you are subject to the Workers' Compensation Laws of California, you must promptly file a certificate of Workers' Compensation Insurance with City of La Quinta. If you have a certificate of self-insurance from the DIR, you must file that certificate with City of La Quinta. When completing this form, remember that the term "employee" includes clerical persons as well as any other persons employed by your company including drivers. ACKNOWLEDGMENT AA.,initial) California Labor Code § 3700 requires employers to carry workers' compensation insurance or to obtain a certificate from the Director of Industrial Relations demonstrating that the employer is self -insured. California Labor Code § 3700.5 makes it a criminal offense for an employer to fail to secure compensation as required by the workers' compensation provisions of the Labor Code. Violation of Labor Code § 3700 is punishable by a fine of up to $10,000 and/or imprisonment for up to one year. _Mlitial) California Labor Code § 3710.1 provides that where an employer fails to provide compensation required under § 3700, the Director of the Department of Industrial Relations shall issue a stop order, prohibiting the employer from using employee labor until such time as the employer complies with the provisions of § 3700. Labor Code § 3710.2 makes it a criminal offense to disregard s s op orders. 'initial I acknowledge that if evidence is found that contradicts this declaration City of Quinta g y La Q to will promptly notify all relevant state agencies to ensure full insurance compliance required by Workers' Comensation Laws of California. ?L7(initial) I understand that California Labor Code § 3700 et seq. requires employers to provide workers' compensation insurance coverage for any employees of my business. I hereby warrant that this business is exempt from the California Labor Code provisions regarding workers' compensation insurance because it has no employees. itial) I agree to hold City of La Quinta and its officers, officials, employees, and agents harmless for loss or liability which may arise from the failure of my business to comply with the laws of the State X Tn'itial) nia regarding workers' compensation insurance. If I hire employees in the future, I will immediately notify City of La Quinta and provide a certified Workers' Compensation certificate to the City. CERTIFICATION I (we) certify under penalty of perjury, under the laws of the State of California, that I (we) have read and understood the above stated requirements regarding Workers' Compensation and that I(we) am (are) in compliance. I(we) certify that the forgoing is true and correct. 11th 1 La Quinta Executed this day of November 20? at ,California Signature of Declarant Paul Anderson Print Name of Declarant Scope Events LLC Print Name of Company ®llformstack sign a> Document Completion Certificate Document Reference : e8d3490c-c885-4fb7-99c1-deb973el5cf17aeb4851-bfc4-4977-9d35-7cle0f5ad4cl Document Title Scope Events policy Document Region Northern Virginia Sender Name Nicholas Charton Sender Email : nick.charton@gasparinsurance.com Total Document Pages 61 (2 page(s) attached here) Secondary Security ; Not Required Participants 1. Paul Anderson (paa53@hotmail.com) 2. Nicholas Charton (nick.charton@gasparinsurance.com) Document History Timestamp Description 11/09/2021 22:05PM UTC Document sent by Nicholas Charton (nick.charton@gasparinsurance.com). 11/09/2021 22:06PM UTC Email sent to Paul Anderson (paa53@hotmail.com). 11/09/2021 22:06PM UTC Email sent to Nicholas Charton (nick.charton@gasparinsurance.com). 11/09/2021 22:45PM UTC Document viewed by Paul Anderson (paa53@hotmail.com). 174.195.143.84 Mozilla/5.0 (iPhone; CPU iPhone OS 14_8 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) Version/14.1.2 Mobile/15E148 Safari/604.1 11/09/2021 22:50PM UTC Paul Anderson (paa53@hotmail.com) has agreed to terms of service and to do business electronically with Nicholas Charton (nick.charton@gasparinsurance.com). 174.195.143.84 Mozilla/5.0 (iPhone; CPU iPhone OS 14_8 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) Version/14.1.2 Mobile/15E148 Safari/604.1 11/09/2021 22:50PM UTC Signed by Paul Anderson (paa53@hotmail.com). 174.195.143.84 Mozilla/5.0 (iPhone; CPU iPhone OS 14_8 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) Version/14:1.2 Mobile/15E148 Safari/604.1 11/09/2021 22:50PM UTC Paul Anderson (paa53@hotmail.com) has agreed to terms of service and to do business electronically with Nicholas Charton (nick.charton@gasparinsurance.com). 174.195.143.84 Mozilla/5.0 (iPhone; CPU iPhone OS 14_8 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) Version/14.1.2 Mobile/15E148 Safari/604.1 11/09/2021 22:50PM UTC Signed by Paul Anderson (paa53@hotmail.com). 174.195.143.84 Mozilla/5.0 (iPhone; CPU iPhone OS 14_8 like Mac OS X) AppleWebKit/605.1.15 (KHTML, like Gecko) Version/14.1.2 Mobile/15E148 Safari/604.1 11/09/2021 22:51PM UTC Email sent to Nicholas Charton (nick.charton@gasparinsurance.com). 11/09/2021 22:51PM UTC Email sent to Nicholas Charton (nick.charton@gasparinsurance.com). 11/09/2021 22:59PM UTC Document viewed by Nicholas Charton (nick.charton@gasparinsurance.com). 12.244.72.150 Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/90.0.4430.93 Safari/537.36 11/09/2021 23:01PM UTC Nicholas Charton (nick.charton@gasparinsurance.com) has agreed to terms of service and to do business electronically with Nicholas Charton (nick.charton@gasparinsurance.com). 12.244.72.150 Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/90.0.4430.93 Safari/537.36 11/09/2021 23:01PM UTC Signed by Nicholas Charton (nick.charton@gasparinsurance.com). 12.244.72.150 Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/90.0.4430.93 Safari/537.36 Document History Timestamp Description 11/09/2021 23:01PM UTC Document copy sent to Nicholas Charton (nick.chartonMgasparinsurance.com). 11/09/2021 23:01PM UTC Document copy sent to Paul Anderson (paa53@hotmail.com).