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Insurance Certificates 2022/23 Old Town Artisan StudioFARMERS INSURANCE Notice of Cancellation 026/022 000390 0606264446{0}56L2221115002636 This notice is issued by: TRUCK INSURANCE EXCHANGE Date: 11 / 15/22 Property Location: (If other than shown below) Poiicy Or Certificate Number(s) 60626-44-46 Agent Number 99-68-514 Cancellation Date 02/17/23 Named Insured And Mailing Address: OLD TOWN ARTISAN STUDIO 78046 CALLE BARCELONA LA QUINTA CA 92253-3932 Notice of Cancellation Of Mortgagee Or Other Interest ® You are hereby notified, that all coverage extended to you under the above listed policy is cancelled effective on the cancellation date shown above at the time specified in the Declarations of this policy, unless you have been notified of a more recent cancellation under other provisions of the policy. ❑ You are hereby notified that all coverage extended to you under the above policy(ies) or certificate(s) on: is cancelled effective on the cancellation date shown above at the time specified in the Declarations of this policy, unless you have been notified of a more recent cancellation under other provisions of the policy. Note to Mortgagee: Your loan with this policyholder may have expired, however, this notice complies with the provision of our policy. Loan Number: Mortgagee or Other Interest: CITY OF LA QUINTA 78495 CALLE TAMPICO LA QUINTA CA 92253 25-5096 5-02 MORTGAGEE, BUREAU, COMMISSIONS A5096131 OR OTHER INTEREST COPY ACORD® CERTIFICATE OF LIABILITY INSURANCE �� DATE (MMIDDIYYYY) 11/16/2022 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 Ron Henderson Insurance Agency 73185 Hwy111, Ste D Palm Desert CA 92260 CONTACT NAME: Ron Henderson ONA (A//CC, No, Ext): (760) 773-0178 (A//C, No): (760) 773-5356 ADDRE commercial@ronhendersonins.com ADDRESS: C INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : TRUCK INS EXCH 21709 INSURED Old Town Artisan Studio 78046 Calle Barcelona La Quinta CA 92253 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 INTR LLIMITS TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY POLICY EXP (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y 606264446 02/17/2022 02/17/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE RENTED PREMISESO(Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE XHIRED LIABILITY ANY AUTO OWNED X/ /N X SCHEDULED AUTOS NON -OWNED AUTOS ONLY 606264446 02/17/2022 02/17/2023 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 606616601 02/17/2022 02/17/2023 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of La Quinta listed as Additional Insured with Primary and Non -Contributory and Waiver of Subrogation as per policy provisions. CERTIFICATE HOLDER CANCELLATION 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 S2----.-....,4.—,.�� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 606264446 t7A FARMERS INSURANCE ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS J6840 2nd Edition With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): CITY OF LA QUINTA Location Of Covered Operation(s): 78046 CALLE BARCELONA LA QUINTA, CA 92253 Effective Date Of Endorsement: 07/30/2019 If no entry appears above, information required to complete this endorsement will be shown in the Declarations. The BUSINESSOWNERS LIABILITY COVERAGE FORM is amended as follows: A. With respect to the additional insured described in Paragraph B. of this endorsement, the following exclusions are added to Paragraph 1. Applicable To Business Liability Coverage under Section B. Exclusions: This insurance does not apply to: 1. "Bodily injury" or "property damage" for which the additional insured(s) is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insured(s) would have in the absence of the contract or agreement. 2. "Bodily injury" or "property damage" occurring after: a. Your ongoing operations at the location of covered operations other than service maintenance or repairs performed by you or on your behalf have been completed; or b. The portion of your ongoing operation out of which the "bodily injury" or "property damage" arises has been put to its intended use by any person or organization. But in no event shall this insurance apply to "bodily injury" or "property damage" arising out of your operations that were completed prior to the effective date of this endorsement. 3. "Bodily injury" or "property damage" arising out of any act or omission of the additional insured(s) or any of its "employees", agents or contractors other than you, except for general supervision by the additional insured(s) of your ongoing operations performed for that additional insured. 4. "Property damage" to: a. Property owned, used or occupied by or rented to the additional insured(s); b. Property in the care custody or control of the additional insured(s) or over which the additional insured(s) exercise physical control; or c. Any work including materials, parts or equipment furnished in connection with such work which is performed for the additional insured by you. J6840-ED2 09-18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 93-6840 Page 1 of2 J6840201 B. Section C. Who Is An Insured is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only to the extent that the additional insured(s) is held liable for "bodily injury" or "property damage" caused in whole or in part by: 1. Your ongoing operations performed for such person or organization at the location designated above; 2. The acts or omissions of your subcontractors acting on "your" behalf on the scheduled project in the performance of your ongoing operations for the additional insured(s) which start and are completed within the effective period of this endorsement; or 3. The acts or omissions of such additional insured(s) in connection with its general supervision of such operations. C. With respect to this endorsement, "wrap up policy" means an Owner or Contractor Controlled Insurance Program providing one or a series of policies designed to cover a specific construction project that insures all of the persons and entities working on such project. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended as follows: A. With respect to the additional insured described in Paragraph B. of this endorsement, Section H. Other Insurance is replaced by the following: H. Other Insurance 1. Primary and Noncontributory Insurance The coverage provided to an additional insured under this endorsement shall be primary and noncontributory ONLY to any insurance issued directly to the additional insured if: a. The Named Insured agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis; b. Such written contract or written agreement referenced in a. above was executed prior to the issuance of this endorsement; c. The additional insured designated herein has a policy with an Other Insurance provision making that policy excess; and d. There is no "wrap up policy" in effect for the work performed at the location designated in the Schedule of this endorsement. 2. Excess Insurance If there is other valid and collectable insurance available to the additional insured(s) as an additional insured under other policies covering the work performed at the location designated and described in the schedule of this endorsement, this insurance will be excess over those policies. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. J6840-ED2 09-18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 93-6840 Page 2 of 2 J6840202 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FARM E RS' WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: Businessowners Common Policy Conditions SCHEDULE Name of Person(s) or Organization(s): CITY OF LA QUINTA Condition K., Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: 3. We waive any right of recovery we may have against the person(s) or organization(s) shown above because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products -completed operations hazard" done under a written contract with that person(s) or organization(s). This waiver applies only to the person(s) or organization(s) shown in the Schedule above. E0012 1st Edition This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. 91-0012 1ST EDITION 9-00 Includes Copyright Material, Insurance Services, Inc., with its permission. E0012101 PAGE 1 OF 1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/12/2022 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 be endorsed. If SUBROGATIONIS 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 CONTACT NAME: AUTOMATIC DATA PROCESSING INS AGCY 76250875 PHONE (800) 524-7024 (A/C, No, Ext): FAX (A/C, No): 1 ADP BLVD MIS 625 ROSELAND NJ 07068 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Property and Casualty Insurance Company of Hartford 34690 INSURED INSURER B : OLD TOWN ARTISAN STUDIO INSURERC: 78046 CALLE BARCELONA STE 1 INSURER D : LA QUINTA CA 92253 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY El PRO —1LOC JECT PRODUCTS -COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANY YIN A PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A X 76WEGAA8MGT 01/01/2022 01/01/2023 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION The City of La Quinta SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 78495 CALLE TAMPICO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED LA QUINTA CA 92253-2839 IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE �AUTHORIZED © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED AUTOMATIC DATA PROCESSING INS AGCY OLD TOWN ARTISAN STUDIO 78046 CALLE BARCELONA STE 1 POLICY NUMBER SEE ACORD 25 LA QUINTA CA 92253 CARRIER NAIC CODE SEE ACORD 25 EFFECTIVE DATE: SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. RE: State job is performed in: CA Policy Location for Employees Performing Job (Work Comp): 78046 CALLE BARCELONA, LA QUINTA, CA 92253-3932 Payroll forjob to support waiver (Work Comp): 0 ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD