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Insurance Certificates 2022/23 Merchants Building Maintenance LLCSHOULD 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 5/31/2022 Bolton Insurance Services LLC 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (626) 799-7000 (626) 583-2117 www.boltonco.com 6004772 Cheryl Feia Merchants Building Maintenance LLC 1190 Monterey Pass Road Monterey Park CA 91754 68542486 3 3 GL Additional Insured applies per CG81860319 attached, only if required by written contract/agreement. XSWC Waiver of Subrogation applies per 0456000113XWC attached. City of La Quinta 78495 Calle Tampico La Quinta CA 92253 Workers Comp is Self-Insured under California Certificate of Consent to Self Insure #1793 for California operations. GL Primary & Non-Contributory Wording applies per CG20010413 attached. Additional Insured(s): City of La Quinta, its officials, employees and agents. A 1,000,000ACP30487352986/1/2022 6/1/2023 1,000,000 3 0 3 1,000,000 2,000,000 2.000,0003 A ACP3048735298 6/1/2022 6/1/2023 1,000,000 3 D ACP3048735298 6/1/2022 6/1/2023 5,000,00033 5,000,000 0 B SP4066615 Excess WC (CA)6/1/2022 6/1/2023 3 E MEWC336956 (AOS)1/1/2022 1/1/2023 1,000,000 1,000,000 1,000,000 C Fidelity/3rd Party Crime 81585028 6/1/2022 6/1/2023 Limit $1 MIL/Ded. $25,000 A Rented Equipment ACP3048735298 6/1/2022 6/1/2023 Limit: $40,000/item; Ded. $2,500 F Excess Liability - Occurrence TUE257195104 6/1/2022 6/1/2023 $5,000,000 Excess of $5,000,000 Umbrella Nationwide Mutual Insurance Company (A+XV)23787 Safety National Casualty Corporation (A+ XIV)15105 Federal Insurance Company (A++XV)20281 AMCO Insurance Company (A+XV)19100 Berkshire Hathaway Homestate Ins Co (A++XV)20044 Great American Insurance Company (A+XIV)16691 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 1 of 6 CG 81 86 03 19 Page 2 of 7 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 81 86 03 19 1. Additional Insured – Automatic Status When Required In An Agreement Or Contract With You SECTION II – WHO IS AN INSURED is amended to include: 1. Any person(s) or organization(s) whom you are required to add as an additional insured on this policy under a written contract or written agreement, provided the written contract or written agreement: (1) Is currently in effect or becomes effective during the term or this policy; and (2) Was executed prior to the “bodily injury,” “property damage” or “personal and advertising injury” for which the additional insured seeks coverage. The person or organization added as an additional insured by this endorsement is an additional insured only with respect to liability for: 1. “Bodily injury” or “property damage” or 2. “Personal and advertising injury”; due to: a. Controlling Interest – with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. b. Co-owner of Insured Premises – with respect to the co-owner’s liability as a co-owner of such premises. c. Grantor of Franchise or License Any person or organization that has granted you a franchise or license by written contract or agreement is an additional insured, but only with respect to their liability as a grantor of a franchise or license to you. However, their status as additional insured under this policy ends when their contract or agreement with you granting the franchise or license ends. d. Lessors of Leased Equipment – with respect to their liability for “bodily injury”, “property damage”, or “personal and advertising injury”, caused in whole or in part by your maintenance, operation, or use of equipment leased to you by such person(s) or organization(s). This insurance does not apply to any “occurrence” which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. e. Lessor of Land – with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to be a tenant in that premise; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. f. Managers or Lessors of Premises – with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. This insurance does not apply to: (1) Any “occurrence” which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new con- struction, or demolition operations performed by or on behalf of the person or organization. ACP3048735298 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 2 of 6 CG 81 86 03 19 CG 81 86 03 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 However, their status as additional insured under this policy ends when you cease to be a tenant of such premises. g. Mortgagee, Assignee or Receiver – with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premise by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. h. Owners, Lessees, or Contractors – 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 performed for that additional insured, whether the work is performed by you or on your behalf; or (3) “Your work” performed for that additional insured and included in the “products-completed operations hazard.” The insurance does not apply to: (a) “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of or the failure to render any professional architectural, engineering, or survey services, including: (i) The preparing, approv- ing, or failing to prepare or approve maps, shop drawings, opinions, reports, survey, field orders, change orders, or drawings and specifications; or (ii) Supervisory, inspection, architectural or engi- neering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the “occurrence” which caused the “bodily injury” or “property damage”, or the offense which caused the “personal and advertising injury”, involved the rendering of, or failure to render, any professional, architectural, engineering, or surveying services. i. State or Political Subdivision – Permits Relating to Premises – with respect to the following hazards for which the state or political subdivision has issued a permit or authorization in connection with premises you own, rent, or control and to which this insurance applies. (1) The existence, maintenance, repair, construction, erection, or removal of advertising, signs, awnings, canopies, cellar entrances, coal holes, drive- ways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (1) “Bodily injury” or “property damage” or “personal or advertising injury” arising out of operations performed for the state or municipality; or (2) “Bodily injury” or “property damage” included within the “products-completed operations hazard”. 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 3 of 6 CG 81 86 03 19 Page 4 of 7 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 81 86 03 19 However, such state or political subdivision’s status as additional insured under this policy ends when the permit ends. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. The insurance afforded to such additional insureds described in a.- i. above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than any coverage requirement in a contract or agreement to provide for such additional insured. 2. Aggregate Limit Per Project Under SECTION III – LIMITS OF INSURANCE, the following paragraph is added to Paragraph 2: The General Aggregate Limit under SECTION III LIMITS OF INSURANCE applies separately to each of your construction projects away from premises owned by or rented to you. 3. Blanket Waiver Of Subrogation Under SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. “Your work” included in the “products completed operations hazard.” However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term or this policy; and b. Was executed prior to loss. 4. Broad Form Named Insured Under SECTION II – WHO IS AN INSURED, the following is added to Paragraph 2: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions, or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. 5. Broadened Bodily Injury Definition (Mental Anguish) Under SECTION V – DEFINITIONS, Definition 3. “Bodily Injury” is replaced with: 3. “Bodily injury” means physical injury, sickness, or disease to a person and if arising out of the foregoing, mental anguish, mental injury, shock, or humiliation, including death at any time resulting therefrom. 6. Broadened Liability Coverage for Damage to “Your Product” and “Your Work” Under SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusions k. and l. and replace them with the following: This insurance does not apply to: k. Damage to Your Product “Property damage” to “your product” arising out of it or any part of it except when caused by or resulting from: (1) Fire; (2) Smoke; (3) Collapse; or (4) Explosion. l. Damage to Your Work “Property damage” to “your work” arising out of it or any part of it and included in the “products-completed operations hazard”. This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor; or (2) If the cause of loss to the damaged work arises as a result of: (a) Fire; (b) Smoke; 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 4 of 6 CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 PRODUCTS/COMPLETED OPERATIONS 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 insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named In- sured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insur- ance would be primary and would not seek contribution from any other insur- ance available to the additional insured. ACP3048735298 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 5 of 6 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time June 1, 2022 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contrac t that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attach to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No SP4066615 issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to MERCHANTS BUILDING MAINTENANCE COMPANY, ET AL, dated June 1, 2022. SAFETY NATIONAL CASUALTY CORPORATION Secretary President 68542486 | MERCH-1 | (1) MBM 6.1.22 renewal, 1.1.22 OOS WC | Nancy Cadwallader | 5/31/2022 3:37:18 PM (PDT) | Page 6 of 6