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Insurance Certificates 2022/23 Precision Concrete Cutting► � CERTIFICATE OF LIABILITY INSURANCE DAT 04/14D/YYYY) 04/14/23 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 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 CONTACT NAME: Progressive Progressive Tower Insurance Service A No Ext : (818)704-1068 RA No): (818)812-7854 ADDRESS: jason@progressiveins.net 16530 Ventura Blvd, Suite 612 INSURER(S) AFFORDING COVERAGE NAIC # Encino, CA 91436 INSURER A: EVANSTON INSURANCE COMPANY Phone (818) 704-1068 Fax (818) 812-7854 INSURED INSURER B : INSURER C : EVANSTON INSURANCE COMPANY Safe Sidewalks Incorporated DBA Precision Concrete Cutting INSURER D : INSURANCE COMPANY OF THE WEST 5737 Kanan Road, #718 INSURER E : Agoura Hills, CA 91301- 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 ADD INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE W OCCUR ❑ Y Y 3AA615388 10/28/2022 10/28/2023 EACH OCCURRENCE $ 1,000,000.00 DAMAGE ( RENTED PREMISESS Ea occurrence) $ 100 000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER ❑� POLICY ❑ PE OT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS ❑HIRED AUTOS NON -OWNED ❑ AUTOS ❑ ❑ COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE Per accident $ $ C ❑ UMBRELLA LIAB ❑ OCCUR EXCESS LIAB RV EXCESS Y EZXS3095693 10/28/2022 10/28/2023 06/11/2023 EACH OCCURRENCE $ 2,000,000.00 AGGREGATE $ 2,000,000.00 ❑ DED ❑ RETENTION$ WC S AT LIMITS ❑ ERH TORY $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER ER EXCLUDED? ANY ECUTIVE (Mandatory in NH) � If yes, describe unde DESCRIPTION OF OPERATIONS below N /A WSD 5066077 00 06/11/2022 CPLMOL107603 08/02/2022 E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1 ,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 E ENVIRONMENTAL / POLLUTION 08/02/2023 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CITY OF LA QUINTA PUBLIC WORKS MAINTENANCE & OPERATIONS 781106 FRANCIS HACK LN. LA QUINTA, CA 92253 CANCELLATION 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 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the : COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Coverage Amount and Basis of Deductible PER CLAIM or PER OCCURRENCE Bodily Injury $ $ OR Property Damage Liability $ $ OR Bodily Injury Liability and/or $ 3.580 $ Property Damage Liability Combined (if no entry appears above, information required tocomplete this endorsement will beshown inthe Declarations oaapplicable tothis endorsement.) APPLICATION OF ENDORSEMENT (Enter below any limitations 'on the application of this endorsement. If no limitation is entensd, the deductibles apply to damages for all "bodily injury" and "property damage", however A. Our obligation under the Bodily Injury Liability and Property Damage Liability Coverages to pay damages on your behalf applies only to the amount of damages in excess of any deductible amounts stated in the Schedule above as applicable to such coverages. B. You may select o deductible amount on either per claim or o per "occurrence" basis. Your selected deductible applies buthe coverage option and tothe basis ofthe deductible indicated bythe placement of the deductible amount in the Schedule above. The deductible amount stated in the Schedule above applies aofollows: 1. PER CLAIM BASIS. |fthe deductible amount indicated in the Schedule above is on a per claim basis, that deductible applies aofollows: a' Under Bodily Injury Liability CoveraQe, to all damages sustained by any one person because of "bodily injury"; b.Under Property Damage Liability Coverage, to all dannogan sustained by any one person because of"property dammge";uv o' Under Bodily Liability and/or Property Damage Liability Coverage Combinmd, to all damages sustained by any one person because ot (1) "Bodily injury"; (2) "Property damage"; or (3) "Bodily injury" and "property damage" combined oothe result ofany one ^occurnanoe". K damages are claimed for can», loss of services or death resulting at any time from "bodily injury", m separate deductible amount will heapplied toeach person making a claim for such damages. With respect to "property damoge", person includes anorganization. CG 03 000196 Copyright, Insurance Services Office, Inc., 1994 Page 1wf 2 0 2. PER OCCURRENCE BASIS. If the deductible amount indicated in the Schedule above is on a "per occurrence" basis, that deductible amount applies as follows: a. Under Bodily Injury Liability Coverage, to all damages because of "bodily injury'; b. Under Property Damage Liability Coverage, to all damages because of "property damage'; or c. Under Bodily Injury Liability and/or Property Damage Liability Coverage Combined, to all damages because of: (1) 'Bodily injury"; (2) "Property damage"; or (3) 'Bodily injury" and "property damage" combined as the result of any one `occurrence", regardless of the number of persons or organizations who sustain damages because of that occurrence". C. The terms of this insurance, including those with respect to: 1. Our right and duty to defend the insured against any "suits" seeking those damages; and 2. Your duties in the event of an 'occurrence", claim, or "suit" apply irrespective of the application of the deductible amount. D. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1994 CG 03 00 0196 13 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Insured under such other 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 insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 CG20331219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i A . r r * r r r � This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "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 surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering 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 the failure to render any professional architectural, engineering or surveying services. CIS 20 33 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 2. 'Bodily injury" or "property damage" occurring after: a. 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 b. 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 3312 19 CG20391219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for that additional insured and included in the "products -completed operations hazard". However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering 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" involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 39 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST ♦. OTHERS • ♦ • OF SUBROGATION) AUTDMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS 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 any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 24 53 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET (Ed. 8-00) 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 ALL CALIFORNIA ORGANIZATION FOR OPERATIONS. WHICH THIS WAIVER IS REQUIRED. Policy Number: WSD 5066077-00 Endorsement Effective: 6/11/2022 Issue Date: 6/17/2022 WC 99 06 34 (Ed. 8-00) Job Description ALL CALIFORNIA OPERATIONS Insured: Safe Sidewalks Inc Coverage Provided by: Ins Co of the West Countersigned by: