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Insurance Certificates 2022/23 Acorn Technology Services06/28/2022 Katie Baughantechrug Technology Risk Underwriting Group 596-600 Enterprise Drive Lewis Center, Ohio 43035 614-842-6686 614-888-2739 katieb@techrug.com RLI INS CO 13056 CU Technology LLC dba Acorn Technology Services 1960 Chicago Ave. Suite E9 Riverside, CA 92507 Hamilton Insurance DAC A0765 A Y Y A Y Y A Y Errors and Omissions InsuranceB 06/01/2022 06/01/2023 $2,000.000B1180D221573/038 City of La Quinta is an additional insured per the terms of the written contract with respect to the General (Form PPB 304G 04 13) and Automobile (Form PPA 300 03 13) Liability policies. The General (Form PPB 304G 04 13) and Automobile (Form PPA 300 03 13) insurance policies shall be primary and non-contributory with any coverage held by the additional insureds. A waiver of subrogation in favor of the additional insureds applies to the General (Form PPB 304G 04 13), Automobile (Form PPA 300 03 13) and Workers Compensation Policies (Form WC 04 03 06) per written contract. City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 PTB0001949 06/01/2022 06/01/2023 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 PTA0001217 06/01/2022 06/01/2023 1,000,000 PTW0001346 06/01/2022 06/01/2023 1,000,000 1,000,000 1,000,000 $2,000,000 Each Claim Aggregate ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: 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 AGG $JECT OTHER:$ 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 LIMIT $DESCRIPTION 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. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE A� o® CERTIFICATE OF LIABILITY INSURANCE N°°°"Y") /2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHREPRESENTATIVE MTHIS OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: Ifthe certificele holder is anADDITIONAL INSURED, the policy(ies) must ba endorsed. If SUBROGATION IS WAIVEDthe terms and conditions of the policy, certain policies may require an Endorsement. A statement on this certificate does not confMecertificate holder in lieu of such andorsement(s). PROOVCE0. Xellogg a Moreland Agency, xnc. DEA CONT CT NAMEJulie Aybek PNoxE BAN1909)T92-8950 P"uc Nond A006ESS: Tulier8arrcyoins. com ALLOYO InaVranCe Services 1654 Plum Lane INSUMMSI AFFORDING COVERAGE NAIL X INSURERA:Federal Ins CO 20281 Redlands CA 92374-4532 INSURED INSURER.; Alle riCa FirlanC]al Benefit IRSYLMCO r 41840 INSURER C: Mighty Oak TeCMOloW, DEA: Acorn Technology Services INSURER o: 1960 Chicago Ave NE9 INSURERS: INSURERF: R VBLSide CA 92507 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CRANY 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. INSR R TYPE OF WSURANCE POI-KYNUMBER MPOLICTEFF X w YY LISTS X COMMERCWLGEN.LLIPMUW EACH OCCURRENCE $ 1,000,000 A LLAIM&MADE X� OCCUR PREMISES b BiC1VGad MED EXP(A m Damon) S 10,000 X 3M3-35-68 PQ 9/1.12 22 3/20/3029 PERSONAL BAW INJURY S 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENEINLLAGGREGATE $ 2,000,000 PRO°UCTS-COMP/OPAGG 5 2, 000, DOB FOLICY1:1 PRP LOC OTXER. AUTOMOBILE LMBIl1TY COMBINED IN LE IMIT S 1,j0,OANYAUTO BODILY INJUW(Per PoCOn) bAALL OWNED SCHEDULEDAUO$T35R-6B-669@0/2022 X AUTOSSUMBRELLA 3/20/2033 BC°ILY INJURY PeI'acitlen0 SDEGENCNE° PROPENTY DAMAGE SHIREOAUIOS LAB X MCVR EACH OCCURRENCE S lO AGGREGATE 5 10 AEXCESS WB CLAIMSMA°E CEO I FRflON 5 S 1983-27-01 3/20/2022 9 20/2023 WORKERS COMPENSATON AND EMPLOYTa3'LWBILITY YIN ANYPROPRISISAGGRFRXECVTIVE X PE OTH. E.L EACH ACCIDENT S 11000,000 EL DISEASE -EAEMPLOYEE S 1 000 000 B OFFILERA1aABER E%CWDED] ❑N/A (MeMOmryIn NNI N231961238-02 l/1/2021 71112022 EL.OISE45E-PoLICY LIMIT 5 1,000,000 Nyee.0exn0e u0tltt °ESCRIPTION OFORERATIOW L.1. A eyes. Liability 3539-35-6B NCS 3/20/2022 3/20/2023 S2p00.000 Ammose Ume °ESCFIRMS OF OPERATION 51 LOCATIONS VEHICLES (ACCRO IM, AEEXmnel ReM/ks Scheme, my W aNcNod I1 mom ewes k momme) "City of La Quinta is hereby recognised as additional insured including primary wording per attached form X80022367" CERTIFICATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quints, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 78495 Calls Tampico La Quinta, CA 92253 AUMpiQE° REPRESENTATIVE Julie Rybak/JULIE 4,9" ACORD 25 (2074/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) CH U B B` Liability Insurance Endorsement Policy Period MARCH 20, 2022 TO MARCH 20, 2023 Effective Date MARCH 20. 2022 Policy Number 3583-35-68 WCE Insured MIGHTY OAK TECHNOLOGY DBA ACORN TECHNOLOGY SERVICES Name of Company FEDERAL INSURANCE COMPANY Date Issued MARCH 8, 2022 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: if and then only to the extent the person or organization is described in the Schedule: to the extent such contract or agreement requires the person or organization to be afforded status as an insured; for activities that did not occur, in whole or in part, before the execution of the contract or agreement: and with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: that is mote specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Liability Insurance Additional Insured- Scheduled Person Or Organizatlon cnntlnued Form 80-W-2367(Rev 5-07) Endorsement Page 1 CHUBB` Liability Endorsement (continued) Under Conditions, the following provision is added to the condition filled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule CITY OF LA QUINTA 79495 CALLE TAMPICO LA QUINTA, CA 92253 All other terms and conditions remain unchanged. Authorized Representative !a Liability Insurance Additional Insured- Scheduled Person Or Organization lastpage Form 80-02-2367(Pev. 5-07) Endorsement Page 2 Hanvr`In, W23 D961238 1001674 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTLAUFORNIA 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 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description CITY OF LA QUINTA 78495 CALLE TAMPICO LA QU I NTA, CA 92253 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 Policy No. W23-D961238-01 Endorsement No. Insured Insurance CompanyALLMERICA FINANCIAL BENEFIT INSURANCE I/I/^^1111 Countersigned By i WC D4 03 06 (Ed 04-84) Policy Number: RLI Insurance Company Named Insured: PPB 304G 04 13 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack®FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM - SECTION II – LIABILITY 1. C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to include as an additional insured on this policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a.In the performance of your ongoing operations; b.In connection with premises owned by or rented to you; or c.In connection with “your work” and included within the “product-completed operations hazard”. 2.The insurance provided to the additional insured by this endorsement is limited as follows: a.This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b.This insurance does not apply to the rendering of or failure to render any professional services. c.This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance. 3.The following is added to SECTION III H.2. Other Insurance – COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION II – LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a.The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered into that contract or agreement; or b.The "personal and advertising injury" for which coverage is sought arises out of an offense committed after you have entered into that contract or agreement. 4.The following is added to SECTION III K. 2. Transfer of Rights of Recovery Against Others to Us – COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II – LIABILITY) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal and advertising injury" arising out of "your work" performed by you, or on your behalf, under a contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement with such person or organization entered into by you before the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PTB0001949 CU Technology LLC WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) ©1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT ----CALIFORNIA 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 _____% of the California workers’ compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By 2 RLI Insurance Company All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before the loss. Jobs performed for any person or organization that you have agreed with in a written contract to provide this agreement. PTW0001346 CU Technology LLC 06-01-2022