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Insurance Certificates 2022/23 Ocean Springs TechOCEASPR-02 SGO_NZALEZ AC�R>Da DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/27/2022 [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 License#0757776 co TACT Shirley Kling HUB International Insurance Services Inc. PHONE FAX {951j 231-2572 3000 Executive Parkway LAIC. Ne, Eni. (925 ) 415-1116 LAIC, Ne ; suite 300E . cal.cpu@hubinternational.com San Ramon, CA 94583 INSURED Ocean Springs Tech, Inc. P.O. Box 234 Desert Hot Springs, CA 92240 utual 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 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. ILTR NSR TYPE OF INSURANCE RDA SOBR POLICY NUMBER POLICY EFF MPMLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCUR ENCE $ 1,000,01 CLAIMS -MADE QX OCCUR VOGP003057 5/1/2022 4/1/9093 DAMAGE TQRENTED .. Q 100,01 LAGGREGATE LIMIT APPLIES PER: POLICY 1XI T&- LOC AUTOMOBILE LIABILITY ANY AUTO AC P3007672992 OWNED SCHEDULED AUTOS ONLY _ AUTOS V�N AUOTOS ONLY �' Jl UMBRELLA LIAB A OCCUR EXCESSLIAB CLAIMS -MADE AN1259398 DED I X RETENTION $ 0 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WPL503357106 ANY PROPRIET'ORIPARTNEWEXECUTIVE YIN X [OMaridatoryJ NHj EXCLUOED' N / A If yes, describe under DESCRIPTION OFOPERAT10NC hp.i w 4/1/2022 1 4/1/2023 5/1/2022 1 4/1/2023 4/1/2022 1 4/1/2023 AGG DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more apace Is mq ulred) Certificate holder is listed as Additional Insured with regard to General Liability when required by written Contract per the attached endorsement form CG2010 12119. Primary and no contributory per farm attached VE0973 04/20. Waiver of subrogation applies per form attached CG2404 12119. Waiver of Subrogation with regard to Workers Compensation applies in favor of City of La Quinta when required by written contract per the attached endorsement form WC990634 08100. City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 I ACORD 25 (2016/03) 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. The ACORD name and logo are registered marks of ACORD Policy Number: VOGP003067 CG 20 10 12 19 Insured Name: Ocean Springs Tech, Inc Number: . Effective Date:05/01/2022 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) Locations Of Covered Operations Any person or organization when you have agreed in All locations for which you have agreed in a a written and executed contract, prior to an written and executed contract prior to an "occurrence", that such person or organization be 'occurrence". added as an additional insured on your policy. 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 bylaw; 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. CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. All other terms and conditions of this Policy remain unchanged. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 Policy Number: VOGP003067 VE 09 73 04 20 Insured Name: Ocean Springs Tech, Inc Number: Effective Date: 05/01/2022 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 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 Commercial General Liability insurance available to an additional insured under your policy, but only if: (1) The additional insured is a Named Insured under such other Commercial General Liability 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 Commercial General Liability insurance available to the additional insured. Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured. All other terms and conditions of this Policy remain unchanged. VE 09 73 04 20 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission Policy Number: VOGP003057 CG 24 0412 19 Insured Name: Ocean Springs Tech, Inc Number: Effective Date: 05/01/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Person(s) Or Organization(s): Any person or organization you have agreed in a written and executed contract, prior to an 'occurrence", that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I he following is added to Paragraph B. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL 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 Effective04/01/2022 Policy No. WPL 5033571 06 Endorsement No. Insured OCEAN SPRINGS TECH INC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED OCEASPR-02 A�C"QRO" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 41112022 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 License # 0757776 NAME CT Shirley Kling HUB International Insurance Services Inc. aIc No, Ext ; (925) 415-1116 FAX. No):(951) 231-2572 3000 Executive Parkway Suite 300 D IL cal.cpu@hubinternational.com San Ramon, CA 94583 INSURED Ocean Springs Tech, Inc. P.O. Box 234 Desert Hot Springs, CA 92240 COVERAGES CERTIFICATE NUMBER; kNAT516110Lll2qllll'J-1=1 9 847 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 TYPE OF INSURANCE ,ADD :SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE C OCCUR EACH OCCURRENCE $ _ S DAMAGE TO RENTED P MED EXP (Any one rso S PERSONAL& ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY D TP& LOC OTHER: GENERAL AGGREGATE S PRODUCTS -COMP/OPAGG S $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTEO�S ONLY AUTOS yyry p AUTOS ONLY X nAl�1TN- 5 ONEY ikCP3007672992 4/1/2022 4/1/2023 CO 9BINdED SINGLE LIMIT S 1,000,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident S X PROPERTY DAMAGE Paf aCCldeft[ S S B X UMBRELLA,LIAB EXCESS LIAB X OCCUR CLAIMS -MADE /4N1237430 4/1/2022 5/1/2022 EACH OCCURRENCE $ 4,000,006 AGGREGATE $ DED X RETENTION$ 10,000 Prod/Comp Ops $ 4,000,000 Ci WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X IINPL503357106 4/1/2022 4/1/2023 X PERSTATUTEORH E.L. EACH ACCIDENT 1,000,000 S E.L DISEASE - EA EMPLOYEE S 1,000,000 E.L DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES ACORD 101. Additional Remarks Schedule, maybe attached if more space is required) Waiver of Subrogation with regard to Workers Compensation applies in favor of City of La Quinta when required by written contract per the attached endorsement form WC990634 08/00. ua 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL 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 Effective04/01/2022 Policy No. WPL 5033571 06 Endorsement No. Insured OCEAN SPRINGS TECH INC Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED