Loading...
Insurance Certificates 2021/22 ClearSource FinancialANY 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 CLEAR-1 OP ID: CG 11/16/2021 Coryn Gardiner Clarion Pacific Insurance 2035 N.. Pacific Ave. Santa Cruz, CA 95060 Ryan Deane 831-337-4661 831-612-1810 coryn@pac-risk.com Travelers Property Casualty Co Nationwide Mutual Insurance Co Clearsource Financial Consulting Terry Madsen 7960 Soquel Dr. ste: B363 Aptos, CA 95003 Philadelphia Indemnity B X 2,000,000 X X ACP 3039102473 12/09/2021 12/09/2022 300,000 5,000 2,000,000 4,000,000 X 4,000,000 2,000,000B ACP 3039102473 12/09/2021 12/09/2022 X X XA X UB-8M759710-22-42-G 01/01/2022 01/01/2023 1,000,000 1,000,000 1,000,000 C PHSD1673659 12/09/2021 12/09/2022 Occurence 2,000,000 Aggregate 2,000,000 The City of La Quinta its officers, officers, employees, agents and volunteers are named as additional insured with respect to the operations of the named insured as required by written contract. Waiver of subrogation attached applies to WC. 30 day notice of cancellation to be mailed to certificate holder; 10 day notic for non-payment of premium. City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 831-337-4661 25658 23787 18058 Professional Liab BUSINESSOWNERS PB 04 48 11 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsementmodifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM Section III. LIMITS OF INSURANCE ANDA. The following is addedto Section II. WHO IS AN DEDUCTIBLE:INSURED: If coverageprovided to the additional insured isAny person or organization shown in the required by a contract or agreement, the most weSchedule of this endorsementis also an insured,will pay on behalf of the additional insured is thebut only with respect to liability amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Ofor omissions or the acts or omissions of those Insuranceshown in the Declarations; whicheveracting on your behalf in the performance of your is less.ongoing operations or in connection with your This endorsementshall not increase thepremises owned by or rented to you. applicable Limits Of Insuranceshown in theHowever: Declarations.1. The insurance afforded to such additional insured only applies to the extent permitted C. This insurance, including any duty we have to by law; and defend "suits", does not apply to: 2. If coverage provided to the additional 1. "Bodily injury" or "property damage" that insured is required by a contract or arises out of, in whole or in part, or is a agreement, the insurance afforded to such result of, in whole or in part, the active additional insured will not be broaderthan negligenceof the additional insured shown that which you are required by the contract in the Schedule of this endorsement. or agreementto provide for such additional 2. "Personal and advertising injury" that arisesinsured.out of any independent"personal and B. With respect to the insuranceafforded to these advertising injury" offense committed by the additional insureds, the following is addedto additional insured shown in the Schedule of this endorsement. All terms and conditions of this policy apply unless modified by this endorsement. SCHEDULE Name Of Person Or Organization: CITY OF LA QUINTA, ITS OFFICERS,EMPLOYEES,AGENTS, AND VOLUNTEERS SEE BLANK ENDORSEMENT PB2500 78495 CALLE TAMPICO LA QUINTA CA 922532839 PB 04 48 11 14 Page 1 of 1Includes copyrighted material of Insurance Services Office, Inc., with its permission. ACP BPO 3039102473 INSURED COPY 47 04765 BUSINESSOWNERS PB 60 72 0711 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT TO OTHER INSURANCE CLAUSE FOR ADDITIONAL INSUREDS -PRIMARY AND NON­ CONTRIBUTORY WHEN REQUIRED IN A WRITTEN AGREEMENT OR CONTRACT WITH YOU This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS Only with respect to any additional insured, in the COMMON POLICY CONDITIONS, form PB 00 09, under condition H. OTHER INSURANCE, paragraph 2.a. is replaced by the following: H.OTHERINSURANCE 2.Under any liability coverage provided by this policy, a.If for injury or loss we cover, there is other valid and collectible insurance available to any additional insured under another policy, our obligations are limited as follows: (1)Issued by another insurer, or if there is self insurance or similar risk retention that applies to a loss covered by this policy, then this insurance provided by us shall be excess over such other insurance, unless you have agreed in a written contract or written agreement signed prior to the loss that this insurance shall be primary: (a)Then this insurance is primary. If other insurance is also primary, we will share with all that other insurance as described in d. below; and (b)The coverage afforded by this insurance is non-contributory with the additional insured's own insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured to any other person or organization's policy.; or (2)Issued by us or any of our affiliate companies, that applies to a loss covered by this policy, then only the highest applicable Limit of Insurance shall apply to such loss." This condition does not apply to any policy issued by us that is designed to provide Excess or Umbrella liability insurance. All terms and conditions of this policy apply unless modified by this endorsement. PB 60 72 0711 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ACP BPO 3039102473 INSURED COPY Page 1 of 1 47 04087 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS EMPLOYERS LIABILITY POLICY ENDORSEMENT-CALIFORNIA WORKERS COMPENSATION ENDORSEMENT WC 04 03 06 (01) – POLICY NUMBER: AND UB-8M759710-21-42-G 006 ONE TOWER SQUARE HARTFORD CT 06183 JOB DESCRIPTION COST OF SERVICES STUDY FOR FIRE RELATED FEES 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.) 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. PERSON OR ORGANIZATION SCHEDULE CITY OF LA QUINTA 78-495 CALLE TAMPICO P.O. BOX 1504 LA QUINTA, CA- 92247 PageDATE OF ISSUE: ST ASSIGN: of 110-19-21 1