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Insurance Certificates 2023/24 Desert Oasis Health CareINSURANCE REVIEW W �W FORNIA RE: Insurance Certificate of Liability with endorsements page, for Desert Oasis Health Care offering FREE health screenings. Please list the Contracting Party / Vendor Name, type of agreement to be executed, including any change orders or amendments, and the type of services to be provided. Make sure to list any related Project No. and Project Name. Insurance certificates required per the Agreement: ACCORD Certificate dated 10-days prior or less October 27, 2023 enter ACCORD issue date Commercial General Liability Insurance: �✓ $1,000,000 per occurrence/$2,000,000 aggregate OR $2,000,000 per occurrence/$4,000,000 aggregate �✓ Additional Insured Endorsement naming City of La Quinta �✓ Primary and Non -Contributory Endorsement Automobile Liability: F—]$1,000,000 combined single limit for bodily injury and property damage. Workers' Compensation: �✓ Statutory Limits / Employer's Liability $1,000,000 per accident or disease �✓ Workers' Compensation Endorsement with Waiver of Subrogation ❑ Sole Proprietor Professional Liability (Errors and Omissions): �✓ Errors and Omissions Liability insurance with a limit of not less than $1,000,000 per claim Cyber Liability/Technology Errors and Omissions Liability Insurance: F-1$1,000,000 per occurrence/loss Other: List other insurance types such as - molestation, harassment, etc. Approved by: Date: L / ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/27/2023 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 Arthur J. Gallagher Risk Management Services, LLC 7777 Center Avenue, Suite 400 Huntington Beach CA 92647 CONTACT NAME: PHONE FAX AIC No Ext : 714-799-5500 AIC No), ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Co of America 25674 License#: OD69293 INSURED DESEOAS-01 Desert Medical Group Inc., A California Corporation dba Desert Oasis Healthcare Medical Group INSURERB: The Travelers Indemnity Company of CT 25682 INsuRERc: StarStone Specialty Insurance (Formerly known as T 44776 INSURER D : Safety National Casualty Corporation 15105 275 N. El Cielo Road INSURERE: NORCAL Insurance Company 33200 Palm Springs CA 92262 INSURER F : COVERAGES CERTIFICATE NUMBER:457853930 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 MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6301F993178TIL22 12/8/2022 12/8/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ $300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑ PRO- JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BA2P5815262243G 12/8/2022 12/8/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY C X UMBRELLA LIAB X OCCUR B80611222ALI 12/8/2022 12/8/2023 EACH OCCURRENCE $ $5,000,000 AGGREGATE $ $5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE LDC4049402 8/1/2023 8/1/2024 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $1,000,000 A Property 6301F993178TIL22 12/8/2022 12/8/2023 BPP Limit $6,925,000 E Malpractice 731684N 12/31/2022 12/31/2023 Deductible Per Claim/Aggregate $5,000 $1 M/$3M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Occurrence Form Policies Malpractice Deductible: $50K/$250K Event on11/08/2023 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of La Quinta ACCORDANCE WITH THE POLICY PROVISIONS. 78450 Avenida La Fonda AUTHORIZED REPRESENTATIVE ATTN: Caroline Doran La Quinta CA 92253 A*r � &w� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorseme nt modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The follcuving is added to SECTION II — WHO 15 AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or 'property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of 'your work' to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such Person or organization. The insurance provided to such additional insured is subject to the following provis ions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits_ For the purposes of determining whether this limitation applies, the minimum limits required by the written contractor agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement This provision will not increase the limits of insurance described in Section III — Limits Of Insurance_ (1) Any "bodily injury" "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architeetiiral, engineering or surveying services, including= (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by -your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. e. The additional insured must comply with the following duties: (1) Give us writen notice as soon as practicable of an "occurrence" or an offense which may result in aclaim_ To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offensetook place. (b) The names and addresses of any injured pers ons and w itrresses; and (c) The nature and location of any injury or damage ansing out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit' is brought against insured does not apply to: the additional insured: CG D2 46 0419 0 2D18The Travelers Indgnnibj Company. AI rights reserved. Page 1 of 2 COMMERCLAL GENERAL LIABILITY (a) Immediately record the speciFics of the clai m or "suit" and tile date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or '"suit', cooperate with us in the investigation or settlement of the claim or defense against the "suiC, and otherwise compFjwith all policy conditions. (d) Tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover such additional insured for a loss we caner. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph C, Other Insurance, of Section IY —Commercial General Liability Conditions. Page 2 of 2 t 241 B The Travelers Indennity CcmpaT. All rights mserved. CG D2 46 04 19 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT, SUCH ADDITIONAL ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED BY THE COMPANY. INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE THIS BLANKET WAIVER. THIS FORM APPLIES ONLY TO THE FOLLOWING STATE(S) IF COVERED BY YOUR POLICY. IF A STATE IS NOT LISTED BELOW, THIS FORM DOES NOT APPLY IN THAT STATE. AZ, ID, NV, NY 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 Effective 08/01/2023 Insured HERITAGE PROVIDER NETWORK, INC. Policy No. LDC4049402 Endorsement No. Insurance Company Safety National Casualty Corporation Countersigned By WC 00 03 13 (04 84) © 1983 National Council on Compensation Insurance. Premium $ Included Page 1 of 1 C!DM1`0ERCIAL GENEIIAL LIABILITY J. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The fdlawrng -s added to SECTION II — WHO I5 AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by arty ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising injury" arising out of operations perlomted for the governmental entity; or b. Any "bodily injury' or "property damage" included in the "products -completed operations hazard". K. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph &, Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. L. CONTRACTUAL LIABILITY— RAILROADS I. The following replaces Paragraph c. of the definition of "insured contract' in the DEFINITIONS Section- c. Arty easement or license agreement: 2, Paragraph f.(1) of the definition of "insured contract' in the DEFINITIONS Section is deleted. M. MOBILE MEDICAL OFFICES The fallowing is added to the definition of "mobile equipment' in the DEFINITIONS Section: "Mobile equipment' also means a land vehicle, whether or not subject to a compulsory or financial responsibility law where it is licensed or pnncipally garaged, but only if such land vehicle is owned, operated, rented by or loaned to arty insured and is designed to be a medical mobile office, and then only when such vehicle is in a stationary position and being utilized for providing specific medical, surgical, dental, x-ray or nursing service, treatment, advice or instruction, or for the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. FL DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to- a, Arty premises while rented to you or temporarily occupied by you with permission of the owner, or b. The contents of any premises while such premises is rented to you_ I you rent such premises for a penGd of seven or fewer consecutive days. Page 4 of 4 d 2017 The Traveler: Indemnity CDnnpany. All rights reserved. C G D 5 01 02 19 Includes eopyrighied material ailnsurarr_e Services Office_ Inc. with its perrr ss on. 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