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Insurance Certificates 2022/24 Gonsalves & Son/ ® CERTIFICATE OF LIABILITY INSURANCE ACCo M/DDIYYYY) DATE 2(M(M2/2D23 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 McGee & Thielen Insurance Brokers, Inc. 3840 Rosin Court, Suite 245 Sacramento, CA 95834 www.mcgeethielen.com 0633187 CONT NAMEACT PHONE EXt): 916-646-1919 (A/C, No): 916-646-0995 EAo, MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Company of CT 25682 INSURED Joe A Gonsalves and Sons Inc. 925 L Street Suite 250 Sacramento CA 95814 INSURER B : Hartford Accident and Indemnity Company 22357 INSURER C : INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 73095412 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. INSR TYPE OF INSURANCE INSD DDL NSD SWUBR VD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ ✓ 16609794P909-TCT-22 6/17/2022 6/17/2023 EACH OCCURRENCE $2,000,000 CLAIMS -MADE I OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ Excluded GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OPAGG $4,000,000 $ A AUTOMOBILE ✓ LIABILITY ANY AUTO OWNED ✓ SCHEDULED AUTOS AUTOS ONLYE 16609794P909-TCT-22 6/17/2022 6/17/2023 C O aBINEDt) SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY rdDAMAGE $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N Y N/A j 57WECZ15671 4/1/2023 4/1/2024 ,/ PER STATUTE OOTH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1 ,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is an additional insured per the attached blanket form CG D1 05. Primary and Non -Contributory wording applies per the attached blanket form CG DO 37. Waiver of subrogation applies per the attached endorsement CG2404 10 93 Waiver of subrogation applies to workers compensation per attached WC 040306 form. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico La Qunita 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 Charlotte Brown ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 73095412 *23/24 Master GL/AL/WC Charlotte Brown 2/22/2023 10:24:25 AM (PST) Page 1 of 4 0 In 0 *0100057LQ13800210 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57WECZI5671 Endorsement Number: Effective Date: 4/1/2023 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Joe A Gonsalves and Sons Inc. 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. Person or Organization City of La Quinta 78495 Calle Tampico La Qunita CA 92253 SCHEDULE Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Job Description Authorized Representative Policy Expiration Date: 4/ 1 /2024 73095412 1 *23/24 Master GL/AL/WC Charlotte Brown 12/22/2023 10:24:25 AM (PST) 1 Page 4 of 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/24/2022 McGee & Thielen Insurance Brokers, Inc. 3840 Rosin Court, Suite 245 Sacramento, CA 95834 916-646-1919 916-646-0995 www.mcgeethielen.com 0633187 Travelers Indemnity Company of CT 25682 Hartford Accident and Indemnity Company 22357 A 2,000,000I6609794P909-TCT-22 6/17/2022 6/17/2023 100,000 3 5,000 3 Excluded 2,000,000 2,000,000 A I6609794P909-TCT-22 6/17/2022 6/17/2023 1,000,000 3 3 B 57WECZI5671 4/1/2022 4/1/2023 3 1,000,000Y 1,000,000 1,000,000 Charlotte Brown Joe A Gonsalves and Sons Inc. 925 L Street Suite 250 Sacramento CA 95814 68429715 3 3 3 blanket form CG D0 37. Waiver of subrogation applies per the attached endorsement CG2404 10 93 City of La Quinta 78495 Calle Tampico La Qunita CA 92253 Certificate holder is an additional insured per the attached blanket form CG D1 05. Primary and Non-Contributory wording applies per the attached Waiver of subrogation applies to workers compensation per attached WC 040306 form. 68429715 | *22/23 Master GL/AL/WC | Charlotte Brown | 5/24/2022 11:53:40 AM (PDT) | Page 1 of 5 I6609794P909-TCT-22 68429715 | *22/23 Master GL/AL/WC | Charlotte Brown | 5/24/2022 11:53:40 AM (PDT) | Page 2 of 5 68429715 | *22/23 Master GL/AL/WC | Charlotte Brown | 5/24/2022 11:53:40 AM (PDT) | Page 3 of 5 I6609794P909-TCT-22 68429715 | *22/23 Master GL/AL/WC | Charlotte Brown | 5/24/2022 11:53:40 AM (PDT) | Page 4 of 5 Joe A Gonsalves and Sons Inc. 57WECZI5671 4/1/2022 City of La Quinta 78495 Calle Tampico La Qunita CA 92253 4/1/2023 68429715 | *22/23 Master GL/AL/WC | Charlotte Brown | 5/24/2022 11:53:40 AM (PDT) | Page 5 of 5