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Insurance Certificates 2023/24 Ocean Springs TechOCEASPR-02 CERTIFICATE OF LIABILITY INSURANCE SGONZALEZ DATE (MMIDD/YYYY) 3/31/2023 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 HUB International Insurance Services Inc. 3000 Executive Parkway Suite 300 San Ramon, CA 94583 INSURED Ocean Springs Tech, Inc. P.O. Box 234 Desert Hot Springs, CA 92240 NAhEEACT Shirley Kling PHONE (A/C, No, Ext): (925) 415-1116 mail pL.L cal.c u^^hubInternatlonal.com INSURER(S) AFFORDING COVERAGE INSURER A: Gemini Insurance Company (A c, No):(951) 231-2572 INSURERS : Nationwide Mutual Insurance Company INSURER C : Nautilus Insurance Company INSURER D:Insurance Company of the West INSURER E NAIC # 10833 :23787 17370 ,27847 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 LTR TYPE OF INSURANCE ADDL INSD SUBR. WVD_ POLICY NUMBER POLICY EFF POLICY EXP IMM/DD/YYYY) /MMIDO/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1 Y1 OCCUR X X VCGPO29311 4/1/2023 4/1/2024 DAMAGE TO PREMISES (EaENTED occurrence) $ 100,000 X $5,000 deductible MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 GENE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: S B LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ _AUTOMOBILE X ANY AUTO ACP3017672992 4/1/2023 4/1/2024 BODILY INJURY (Per person) S OWNED AUTOS ONLY — SCHEDULED AUTOS BODILY BODILY INJURY (Per accident) $ X AUTOS ONLY X AUTOS ONLY PROPERTY arc dJ n1DAMAGE $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS -MADE AN1280555 4/1/2023 4/1/2024 AGGREGATE $ 4,000,000 DED X RETENTION $ 0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X I PER I STATUTE OTH- _ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 'WPL503357107 4/1/2023 4/1/2024 EL. EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N N I A 1 E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below El. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) City of La Quinta is Additional Insured with regard to the General Liability policy, when required by written contract, per the attached endorsement form CG2010 12/19. Coverage is Primary & Non —Contributory with regard to the General Liability policy, when required by written contract, per the attached endorsement form VE0973 04/20. Waiver of Subrogation applies to the General Liability policy, when required by written contract, per the attached endorsement form CG2404 12/19. Waiver of Subrogation applies to the Workers Compensation policy, when required by written contract, per the attached endorsement form WC990634 08/00. 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 n n ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: VCGP029311 Insured Name: Ocean Springs Tech, Inc Number: 33 CG 20 10 12 19 Effective Date:04/01/2023 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) Location(s) Of Covered Operations Any person or organization when you have agreed in a written and executed contract, prior to an "occurrence", that such person or organization be added as an additional insured on your policy. All locations for which you have agreed in a written and executed contract prior to an "occurrence". 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 by law; 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. CG 20 10 12 19 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. © 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: VCGP029311 Insured Name: Ocean Springs Tech, Inc Number: 43 VE09730420 Effective Date: 04/01/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURAINCE 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: VCGP029311 Insured Name: Ocean Springs Tech, Inc Number: 37 CG 24 04 12 19 Effective Date: 04/01/2023 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. The following is added to Paragraph 8. 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. CG24041219 © 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 2 % of the total California Workers' Compensation premium otherwise due. Schedule Person or Organization ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 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 Effective04/01/2023 Policy No. WPL 5033571 07 Insured OCEAN SPRINGS TECH INC Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) Endorsement No. Premium $ INCL . INSURED