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Home My WebLink AboutA9227 - TRI-STAR CONTRACTINGTRISCON-02 DNItLS DATE /Y5 � CERTIFICATE OF LIABILITY INSURANCE 1/10/2010/202 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). ER License # 0757776 CONTACT Diane Nielsen NAME: PRODUC �tECEIVEDFAX HUB International Insurance Services In 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 J A N 15 2025 PHONE 760 360-4700 4742 A/C, No):(760) 200-9706 (A/c, No, Ext): ( ) A �RIEss: diane.nielsen@hubinternational.com INSURERS) AFFORDING COVERAGE NAIC # INSURERA:United S ecialt Insurance Com an 12537 INSURED Tri-Star Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER B : Security National Insurance Company 19879 INSURER c : Everest Premier Insurance Company 16045 INSURER D : Travelers Property Casualty Company of America 25674 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 6/26/2024 POLICY EXP LIMITS 6126/2025 EACH OCCURRENCE $ 1,050,000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ] OCCUR $5,000 Deductible X ATN2488856 DAMAGE PREMISES a coccurrence)$ 50,000 MED EXP An one erson $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [ J PRO LOC JECT PRODUCTS - COMPIOP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X AUOTOS ONLY No Deductible SPP181817801 11/23/2024 11/23/2025 COMBINED SINGLE LIMIT E accident) 1,000,000 B BODILY INJURY Perperson) $ BODILY INJURY Per accident PROPERTY DAMAGE Per accident $ X X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NIA BTN2481652 7600005937241 6126/2024 10/1 /2024 6/26/2025 10/1 /2025 EACH OCCURRENCE $ 2,000,000 A AGGREGATE 2,000,000 Over GL & WC PER X STATUTE EERH X DED RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under C E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 ELDISEASE -POLICY LIMIT .. 1,000,000 DESCRIPTION OF OPERATIONS below Installation / Build 6606072C693 1/11/2025 1/11/2026 Leased/Rented 500,000 p DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORIZED REPRESENTATIVE nn• r w neon rn00n0AT1AAI All rinhts rpBprVed ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD TRISCON-02 DNItLS DATE /Y5 � CERTIFICATE OF LIABILITY INSURANCE 1/10/2010/202 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). ER License # 0757776 CONTACT Diane Nielsen NAME: PRODUC �tECEIVEDFAX HUB International Insurance Services In 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 J A N 15 2025 PHONE 760 360-4700 4742 A/C, No):(760) 200-9706 (A/c, No, Ext): ( ) A �RIEss: diane.nielsen@hubinternational.com INSURERS) AFFORDING COVERAGE NAIC # INSURERA:United S ecialt Insurance Com an 12537 INSURED Tri-Star Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER B : Security National Insurance Company 19879 INSURER c : Everest Premier Insurance Company 16045 INSURER D : Travelers Property Casualty Company of America 25674 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 6/26/2024 POLICY EXP LIMITS 6126/2025 EACH OCCURRENCE $ 1,050,000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ] OCCUR $5,000 Deductible X ATN2488856 DAMAGE PREMISES a coccurrence)$ 50,000 MED EXP An one erson $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [ J PRO LOC JECT PRODUCTS - COMPIOP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X AUOTOS ONLY No Deductible SPP181817801 11/23/2024 11/23/2025 COMBINED SINGLE LIMIT E accident) 1,000,000 B BODILY INJURY Perperson) $ BODILY INJURY Per accident PROPERTY DAMAGE Per accident $ X X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE NIA BTN2481652 7600005937241 6126/2024 10/1 /2024 6/26/2025 10/1 /2025 EACH OCCURRENCE $ 2,000,000 A AGGREGATE 2,000,000 Over GL & WC PER X STATUTE EERH X DED RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under C E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 ELDISEASE -POLICY LIMIT .. 1,000,000 DESCRIPTION OF OPERATIONS below Installation / Build 6606072C693 1/11/2025 1/11/2026 Leased/Rented 500,000 p DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORIZED REPRESENTATIVE nn• r w neon rn00n0AT1AAI All rinhts rpBprVed ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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) Locations Of Covered O erations Or Or anizaI s As Required By Written Contract, Fully As Required By Written Contract, Fully Executed Prior To The Named Insured'S Work Executed Prior Togo k Named Insured's Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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: 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. 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. CG 20 10 0413 ©insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 a © insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER,ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 2. This insurance does not apply to: to include as an additional insured any state or a. 'Bodily injury", "property damage" or governmental agency or subdivision or "personal and advertising injury" arising political subdivision shown in the Schedule, out of operations permed for the subject to the following provisions: federal government, state or L. This insurance applies only with respect to municipality; or operations performed by you or on your b. 'Bodily injury" or "property damage" behalf for which the state or governmental included within the "products - agency or subdivision or political completed operations hazard". subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these However: additional insureds, the following is added to Section III — Limits Of Insurance: a. The insurance afforded to such If coverage provided to the additional insured additional insured only applies to the is required by a contract or agreement, the extent permitted by law; and most we will pay on behalf of the additional b. If coverage provided to the additional insured is the amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such additional insured will not be 2. Available under the applicable Limits of broader than that which you are Insurance shown in the Declarations; required by the contract or agreement to whichever is less. provide for such additional insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER•ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section 11 — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 11 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Of Person Or Organization: luired By Written Contract, Fully Executed Prior To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 Policy # ATN2488856 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis, Name Of Persons Or Organization(s) As Required By Written Contract, Fully Executed Prior To The Named lnsured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 fiom us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/ 1 /24 Policy No-7600005937241 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance " Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual -1999. POLICY NUMBER:,SPP181817801 COMMERCIAL AUTO GA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement, If It A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and blanket Additional Insured Status for Certain Entities. Item 1. Who is an insured of Paragraph A. Coverage under SECTION it — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named insured; however, (1) coverage under this provision is afforded only until the 180`4 day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or If similar Insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an insured while operating an "auto" hired or rented under a contract or agreement In that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "Insured", but only with respect to liability created in whole or in part by such agreement. B. increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, Including actual loss of earnings up to $1,000 per day because of time off from work. C, Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION Ii — COVERED AUTOS LIABILITY COVERAGE Is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible Insurance. CA990187 0715 includes Copyrighted Material of Insurance Services Offices, inc. Page 1 of 5 Used with permission D, Limited Automatic Towing Coverage item 2. Towing, of Paragraph DAMAGE A. under SECTION IIi — p}t COVERAGE is amended to read: 2, Towing We will pay for towing and, labor costs each time that a covered "auto" Is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b, No deductible applies to this cover- age. E. Item 3. Glass Breakage -- Hitting A Bird Or Animal — Failing Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is Indicated on your covered "auto", for glass repairs. We wilt repair at no cost to you, any glass that can be repaired without replacement, provided the "toss" arises from a covered Comprehensive "toss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a, Transportation Expenses We will pay up to $50 per day to a maximum of $1,o00 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for Its "loss". G. ,personal Effects" Coverage item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per loss , for that covered "autd' caused by the t fhl$ coverage. No deductible will apply H. "Downtime Loss" Coverage item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION Ill. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5°i day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0716 Includes Copyrighted Material of permissionInsurance Services Offices, Inc, Page 2 of 6 sed Item 4. Coverage Extensions, of d. Contraband or property In the course of illegal transportation or trade. Paragraph A. Coverage, under SECTION Ill. PHYSICAL DAMAGE COVERAGE, is e, "Loss" caused. by theft, unless there is amended to add:. evidence of forced entry Into the covered "auto" and a police report is We will pay any resulting -rental reimbursement expenses incurred by you for filed. a rental of an "auto" because of "loss" to a K. Accidental Alrbag Discharge Coverage covered "auto" up to a maximum of $100 per Item 3.a. of Paragraph 13. Exclusions under day, for a maximum of 30 days for the same SECTION Ill — PHYSICAL DAMAGE physical damage "loss", subject to the COVERAGE Is amended to read: following conditions: a. Wear and tear, freezing, mechanical a, We will provide rental reimbursement or electrical breakdown. The Incurred during the policy period exclusion relating to mechanical -beginning 24 hours after the loss" and break -down does not apply to the ending, regardless of the policy accidental discharge of an air bag. expiration, with the number of days reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto". If the "loss" is caused by theft, this number of days Is Paragraph C. Limit Of Insurance under SECTION Ill — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered "auto" and return it to you or the If a covered "auto" is owned or leased and number of days it takes for the claim to if we provide Physical Damage Coverage be settled, whichever comes first. on It, we will pay, In the event of a covered b. Our payment is limited to necessary and Iota) "loss", any unpaid amount due on the "auto', actual expenses incurred. lease or loan for a covered less: C. This coverage does not apply while a. The amount paid under the Physical Damage Coverage Section of the there are spare or reserve' autos available to you for your operations. policy; and d. if a "toss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects" Exclusion Paragraph 13. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Exclusion We will not pay for "loss" to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. b. Any: (1) Overdue lease or loan payments including penalties. Interest or other charges resulting from overdue payments at the time of the "loss" (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) security deposits not refunded by the lessor; and (6) Carry-over balances from previous loans or teases 10 CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" Involved in the same "loss", only one deductible will apply to that "loss". If the deductible amounts vary by "autos% then only the highest applicable deductible will apply to that "loss". N, Diminishing Deductible Paragraph D. Deductible under SECTION III PHYSICAL DAMAGE COVERAGE Is . ......... ....... .... . amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: if we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated In the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, "suit" or "loss" Is {mown to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item S. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSiNESS AUTO CONDITIONS is amended to.read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to Impair them. However, if the Insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. Insurance is Primary and Noncontributory Subpart a. of Item 6. Other insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required In a written contract with you. R. Other Insurance— Hired Auto Physical Damage Subpart b. of Item 5..0ther Insurance of Paragraph 13, General Conditions under SECTION 1V -- BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (9) Any covered "auto" you lease, hire, rent or borrow; and CA990187 071E Includes Copyrighted Used with permission Services Offices, Inc. Page 4 of 5 (2) Any covered "auto" hired or rented by your "employee" under a contract in that Individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the Inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentlonal. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS Is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or toss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including Payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains In effect. CA990187 0716 Includes Copyrighted Material of Insurance Services Off lees, lnc. page 5 of 5 Used with permission TRISCON 02 DNIELS CERTIFICATE OF LIABILITY INSURANCE D"TEIM"MDD"-"° 11/26/2024 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 eqTndorsement(s). PROOucm License # 0757775 NAW"T Diane Nielsen HUB International Insurance Services Inc. RECEIVED PHONE UVc Nu, Ertl: (760) 3E 75030 Gerald Ford Drive E-MAIL diane.niel Suite 201 - ADDRESS' Palm Desert, CA 92211 INSU DEC 0 2 2024 - - INSURER A : Unfted S WSURm B:$@CUrf OF THE CITY CL Tri-Star Contracting II, InOFFICE Telar, Inc. 15-601 Little Morongo Road _-_---::Everest I INSURER D: Travelers Desert Hot Springs, CA 92240 , msuRERE: 4742 r_ec CERTNarATE HUMBER: RFVISRIN NIIMRFR- v THIS IS TOCERTIFYTHAT 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 AWL INSD SUB p.pLDy NUMBER POLICY EFF POLICY UP-LM Lafi3 A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X X ATN2488856 612612024 6126@025 AMAGETORENTED DPREMISES Me OCOM03CM $ 50,000 $5,000 Deductible X MED UP (Any one 5,000 PERSONAL S ADV INJURY ll 1,000,000 GENL AGGREGATE pL{I�MpIT APPLIES PER: POLICY ❑X JECT LOC GENERALAGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,0 01000 OTHER. B AUTOMOBILE LIABILTY COMBINEDSINGLE LIMIT 1,000,000 BODILVINJURr Par X ANY AUTO X X SPPI8181780I 11/2312024 11/2312025 SCDILY INJURY Par siewleltl AUgT�OS ONLY AAUUTT�OSWUN�EDp X AUTOS ONLY X AN%9 ONLY X No DeducONe WPE=t AMAGE _ A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE STN2481652 6/26/2024 6/26/2025 EACH OCCURRENCE 2,000.000 X AGGREGATE 21000,000 X DED RETENTIONS D Over GL & WC C WORKERS COMPENSATION AND EMPLOYERS' LIABILTY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ AQ�,FICERNE,MggW EXCLUDED? IMsntlMory In NFHI If yes, desrd under DESCRIPTION OF OPERATIONS I,eb NIA X 7600006937241 10/112024 10/1/2025 X PER T T. OTH- E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYE E 1,000,000 E.1- DISEASE - POLICY UNIT 1,000,000 D LeasedlRented 6606072C693 1/11!2024 '1/1112025 Leased/Rented 500,000 DESCRIPTION OF OPERA nONS / LOCATIONS I VEHICLES (ACORD 101, Additional Rems Schedule, my M seethed R more spies Is required The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG201 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration data. 10 days notice applies for non payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 D/eTn/NO��RIZED REPRESENTATIVEV AjN� ACORD 25 (2016103) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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) aniza rrttsa Local! Oered Operations equire enCont, Fully equires Bven Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 locations) designated above. How_ ever: 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. 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 pad of the same project. CG 2010 0413 ©Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER•ATN 2488856 COMMERCIAL GENERAL LIABILITY CG 2012 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State'Or Governmental Agency Or Subdivision Or Political Subdivision: Required By Written Contract, Fully Executed Prior To The Named Insured's Work will be shown A. Section II — Who Is An Insured is amended 2. This insurance does not apply to: to include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political subdivision shown in the Schedule, "personal and advertising inju " arising out of operations performed for the subject to the following provisions: federal government, state or L This insurance applies only with respect to municipality; or operations perfomied by you or on your b. "Bodily injury" or "property damage" behalf for which the state or governmental included within the "products - agency or subdivision or political completed operations hazard". subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these additional insureds, the following is added to However: Section III —Limits Of Insurance: a. The insurance afforded to such additional insured only applies to the If coverage provided to the additional insured extent by law; and is required by a contract or agreement; the permitted most we will pay on behalf of the additional b. If coverage provided to the additional insured is the amount of insurance: insured is required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such additional insured will not be 2. Available under the applicable Limits of broader than that which you are Insurance shown in the Declarations; required by the contract or agreement to whichever is less. provide for such additional insured. This 'endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2012 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER•ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and Included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 Policy # ATN2488856 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following Is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other Insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the speciflc project that is the subject of the claim, "suit," or "occurrence" expressly requires that this Insurance: (L) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other Insurance available to the additional Insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Organization(s) As Required By Written Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 05100 (02120) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/1 /24 Insured: Tri-Star Contracting 1I, Inc. Policy No.7600005937241 Insurance Company: Everest Premier Insuranc^ Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. Endorsement No. 001 Premium $ INCL. POLICY NUMBER:`SPP181817801 COMMERCIAL AUTO CA990187 0716 This Endorsement: Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies Insurance provided by the following: BUSINESS AUTO COVERAGE FORM ........... . . With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement A. Newly Acquired or Formed e. An "employee" of yours Is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement In that Status for Certain Entities, "employee's" name, with your Item 1. Who Is an Insured of Paragraph A. permission, while performing duties Coverage under SECTION 11— COVERED related to the conduct of your business. AUTOS LIABILITY COVERAGE is amended to add; d. Any organization you newly acquire or form, other than a partnership, Joint venture or limited liability company, and over which you maintain ownership of a majority Interest (greater than 60%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 1801' day after you acquire or form the organization or the end of the policy period, whichever Is earlier; (2) coverage does not apply to "bodily Injury", "property damage" or "covered pollution cost or expense" that results from an "accldenr' which occurred before you acquired or formed the organization; and (3) coverage does not apply If there is other similar Insurance available to that organization, or If similar insurance would have been available but for Its termination or the exhaustion of Its limits of Insurance. This insurance does not apply If coverage for the newly acquired or formed organization Is excluded either by the provisions of this coverage form or by endorsement. L Any person or organization you are required by written contract or agreement to name as an additional 'Insured', but only with respect to liability created In whole or In part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses Incurred by the "Insured' at our request, Including actual loss of earnings up to $1,000 par day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II —COVERED AUTOS LIABILITY COVERAGE Is amended to add: This exclusion does not apply If the "bodily injure/' results from the use of a covered "auto" you own or hire. Such coverage ae is afforded by this provision is excess over any other collectible Insurance. CA990187 0716 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 6 Used with permission D. Limped Automatic Towing Coverage G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph Item 2. Touving, of Paragraph A. Coverage, A. Coverage, under SECTION 111- under SECTION III — PRYWCAL DAMAGE PHYSICAL DAMAGE COVERAGE, Is COVERAGE Is amended to read: amended to add: 2. Towing "Personal Effects" Coverage We will pay for towing and labor costs We will pay actual cash value for "loss" to each time that a covered "auto" Is °personal effects" of the "insured° while In disabled. All labor must be performed at a covered °auto" subject to a maximum the place of disablement of the covered limit of $2,500 per °loss", for that covered "auto". "auto" caused by the same °accident°. No a. The limit for towing and labor for deductible will apply to this coverage. each disablement is $500; H. "Downtime Loss" Coverage b, - No deductible applies to this cover- Item 4. Coverage EAbildidiis, of age, Paragraph A. Coverage, under SECTION E. Item 3. Glass Breakage— Hitting A Bird Ill. PHYSICAL DAMAGE COVERAGE, is Or Animal — Falling Objects or Missiles of amended to add: Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, Is "Downtime Loss" Coverage amended to add: We will pay any resulting 0downfirne loss° expenses you sustain as a result of a Glass Repair Coverage covered physical damage'loss" to a We will waive the Comprehensive covered °auto° up to a maximum of $100 deductible for Glass, If one is Indicated on per day, for a maximum of 3o days for the your covered"auto"; for glass repairs. We - same physical damage °loss", subject to will repair at no cost to you, any glass that the following conditions: can be repaired without replacement, provided the 'lose edges from a covered a. We will provlde °downtime loss' beginning othe 5m day after have given you Comprehensive loss, to yourto° °au. r agreement to pay for repairs to a our F. Increase Of Transportation Expense covered °auto' and you have given the Coverage repair facility your authorization to make Subpart a. Transportation Expenses of repairs; item 4. Coverage Extensions of Paragraph b. Coverage for"dovmfime loss° expenses A. Coverage under SECTION III — will and when any of the following occur. PHYSICAL DAMAGE COVERAGE IsYou (1) havb'a o° amended to read: uto continue your available to you a. Transportation Expenses operations. We will pay up to $50 per day to a (2) You putchase a replacement "auto°. maximum of $1,000 for temporary transportation expense Incurred by you (3) Repairs to your covered "auto° have been completed by the repair facility because of the total theft of a covered and they determine the covered n u auto of the private passenger type. 'auto" is road -worthy. We will pay only for those covered "autos" for which you carry either (4) You reach the 30 day maximum Comprehensive or Specified Causes of coverage. Loss Coverage,or Theft Coverage. We will pay for temporary transportation expenses Incurred during the period beginning 48 hours after the theft and ending, regardless of the policys expiration, when the covered "auto" is returned to use or we pay for Its "loss". CA99o187 0715 Includes Copyrighted Used with Material of Insurance services Offices, Inc. Page 2 of 5 . Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION d. Contraband or property In the course of Illegal transportation or trade. Ill. PHYSICAL DAMAGE COVERAGE, Is e, °Loss" caused by theft, unless there Is amended to add:. evidence of forced entry Into the We will pay any resulting -rental covered °auto° and a police report Is reimbursement expenses Incurred by you for filed. a rental of an "auto" because of class' to a K, Accidental Alrbag Discharge Coverage covered "auto" up to a maximum of $100 per Item 3.a. of Paragraph B. Exclusions under day, for a maximum of 30 days for the same SECTION Ill — PHYSICAL DAMAGE physical damage "loss", subject to the COVERAGE Is amended to read: following conditions: a, Wear and tear, freezing, mechanical a. We will provide rental reimbursement or electrical breakdown. The Incurred during the policy period .beginning 24 hours after the close and break-dowexclusion relating to mechanical doesriotapply to the ending, regardless of the policy expiration, with the number of days accidental discharge of an air bag. accidental reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto". If the "loss" Is Paragraph C. Limit Of Insurance under caused by theft, this number of days Is SECTION III — PHYSICAL DAMAGE the number of days It takes to locate the COVERAGE Is amended to add: covered "auto" and return it to you or the number of days It takes for the claim to If a covered "auto" Is owned or leased and be settled, whichever comes first. If we provide Physical Damage Coverage on It, we will pay, In the event of a covered b. Our payment Is limited to necessary and total °loss', any unpaid amount due on the actual expenses Incurred. -- lease or loan for a covered "auto', lose: c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos" Damage Coverage Section of the avelleble to you for your operations. policy; and d. If a "loss" results from the total theft of a b. Any: covered "auto" of the private passenger type, we will pay under this coverage 1 Overdue lease or loan () payments including penalties, payments only that amount of your rental reimbursement expenses which Is not or other charges interest from overdue resulting already provided for under the Physical payments at the time of the Damage Coverage Extension. "loss"; J. "Personal Effects" Exclusion (2) Financial penalties Imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss° to 'personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or tease; evidence of debt, money, notes, securities or commercial paper or (4) Security deposits not refunded ' other documents of value, by the lessor, and b. Bullion, gold, silver, platinum, or other (6) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-preclous stones. c. Paintings, statuary and other works of art. CA990187 0716 Includes Copyrighted Material of Insurance Services offices, Inc. Page 3 of 6 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE Is amended to add: Regardless of the number of covered "autos° Involved In the same "loss", only one deductible will apply to that "loss', If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss°. N. Diminishing Deductible Paragraph D. Deductible under SECTION 1.11.= PHYSICAL DAMAGE COVERAGE Is amended to add; Any deductible will be reduced by the percentage Indicated below on the first "loss° reported during the corresponding policy period: Lose Free Policy Potlods With the Expansion Endorsement Deductible Reduction on the nrst"loss" 1 - 0% 2 25% 3 60% 4 76°h 6 100% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0%for each such COVERAGE FORM if covbrage Is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS Is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, "suit" or "loss" Is known to: (1) You, if you are an Individual; (2) A partner, If you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your Insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 6. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS Is amended tosead: 6. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must _ do nothing after an 'accident" or "loss° toimpairthem. However, if the Insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. insurance Is Primary and Noncontributory Subpart a. of Item S. Other Insurance of Paragraph B. General Conditions under SECTION IV —BUSINESS AUTO CONDITIONS Is amended to read: a. This Insurance Is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 6..0ther Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS Is amended to read: b. For Hired Auto Physlcal Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0716 Includes Copyrighted Material of insurance Services Offices, Inc. Page 4 of 5 Used with permission i (2) Any covered "auto" hired or rented contract in tour hat Iunder a Individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that Is [eased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV- BUSINESS AUTO CONDIa ' TIONS Is amended to add: 9. Your failure to disclose all hazards existing as of the Inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not Intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its - - —discovery:-- T. Additional Definition SECTION V - DEFINITIONS Is amended to add: ,Personal effects" means personal property owned by the 'Insured. 'Downtime loss" means actual loss of "business Income' for the period of time that a covered'auto": 1. Is out of service for repair or replacement as a result of a covered physical damage'loss" and 2. Is In the custody of a repalrfacillty It not a total "loss". 'Business Income' means: 1. Net Income (Net Profit or loss before income taxes) that would have been earned or Incurred; and 2. continuing normal operating expenses Incurred, Including payroll. In this endorsement, Headinas and Titles are Inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA9a0187 0716 includes Copyrighted Material of Insurance Services Offices, Inc. Page 6 of 6 Used with permission TRISCON-02 DNI L E DAY 11126 1 vzsr2o24 ACORa CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . PRODUCER License fl 0757776 MACT Diane Nielsen AX PN N , Eau: (760) 360.4700 4742 IArr xI y.(760) 200-9706 HUB International Insurance Services Inc. 75030 201 Gerald Ford Drive RECEIVED Palm Desert, CA 92211 UEC 0 2 2024 E 1 .diane.nielsen hubintemational.COm INSURER S AFFORDING COVERAGE NAIC p INSURER A: UnitedS eclat Insurance Company 12637 INSURED Tri-Star Contracting II, Inc CITY CLE Telar, Inc. OFFICE OF THE 15-601 Little Morongo Road RERB:Socuri National Insurance Company 19879 RE Everest Premier Insurance Company 16045 INSURER D:Travelam Pro CasualtyCompany of America 25674 Desert Hot Springs, CA 92240 INSURER E: INSURER F: rcorrvlCAre HUMBER: REVI.QION NUMBER - THIS IS TOCERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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 POUCV EXP UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE ❑X OCCUR $5,000 Deductible X TN2488856 6/26/2024 6/26/2025 DAMAGE TO REM'ED 50,000 X MEDEXP Arrone 5,000 PERSONAL&ADV INJURY S 1,000,000 GENL AGGREGATE LpIIMpIIT. APPLIES PER: POLICY Yea El LOC GENERAL AGGREGATE 2,000,000 PRODUCTS -COMPX3P AGO S 2,000,000 $ OTHER: B At, LIABNTY COMBINED SINGLE LIMIT a a.d.Ml 1,000,000 BODILY INJURY Per $ X ANY AUTO SPP181817801 1112312024 11123/2025 BODILY INJURY Pere S OWNED SCHEDULED AUTOSONLY AAUUTNOSS�A.NEp X AUTOS ONLY X AUTOS ONLY X No Deductible R PPe�earaR , AMAGE $ A UMBRELLA LIAB EXCESS LIAB X I OCCUR CLAIMS -MADE STN2481652 6126/2024 6/2612025 EACH OCCURRENCE E 2,000,000 X AGGREGATE 2-,000,000 X DED I I RETENTION$ 0 Over GL & WC C WORKERS COMPENSATION AND EMPLOYERS'LIABILRY YIN AAoNY PROPPRIIEMTgO�RpIPARTNERI0 CUTIVE ❑ (MantlERNatoryIn NH) N/A 7600005937241 1011/2024 10/1/2025 1C I PER OTH- 11 E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOY 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 B yes, describe under DESCRIPTION OF OPERATIONS balms D Leased/Rented 6606072C693 1111/2024 1111/2025 Leased/Rented 500,000 DESCMPTIONOFOPERAnONS/LOCATIONS/VEHICLES (ACORD101, Additional Remarks Scheduk,maybe aNeched Nrame.Rce is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days Written notice YAJI be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) U 196a-ZU1b ACUKUr wnrUPUk I IUn. Au n9nuc mbervVU- The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Or anization s Location s Of Covered Operations As Required y rittan Contract, Fully As equire By ntten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section It — 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 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. 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: 2. 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. 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 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. CG 2010 0413 © Insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 Y1:76YK�7: CIY] DNIELSEN CERTIFICATE OF LIABILITY INSURANCE DATE 9/30/2024 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 endomement(s). PRODUCER License 1110757776 ACT Diane Nielsen HUB International Insurance Services Inc. 75030 Gerald Ford Drive RECEIVED Suite 201 (Alccgq E,u:(760 36047004742 FAx 1 lA1C,No1:(7�) zoo-s7os RMas, diane.nielsen@hubintemational.com INSURER AFFORDING COVERAGE NAICp Palm Desert, CA 92211 Cj 2024 INSURER A:United Specialty Insurance Company 12637 INSURED Tri-Star Contracting II,,�Ij�M OF THE CITY CLER Talar, Inc. OFI'ICE 15-501 Little Morongo Road NsuRERe:S@curi r National Insurance Company INSu:::: Everest Premier Insurance Company 19879 16046 INSURER D: Travelers Prop" Casualty Company of America 25674 INSURER E: Desert Hot Springs, CA 92240 INSURER F: COVERAGES CERTIFICATE NUMBER- REVISION NUMRER- 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 SUER POLICVNUMBER POLICY EFF POLICY UP LIMITS A GENER�A�L LI�ABILITY X OCCUR Deductible X TN2488856 612612024 612612025 EACH OCCURRENCE S 1,000,000CLAIMS-MADE 1yoIMERCIAL DAMAGE TO RENTEDE 50,000$5000 MED EXP An one rwn E 5,000 PERSONAL B ADV INJURY $ 1,000"000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JECT LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGO 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AAryUUpTTryOpSSWWNNEEpp AUTOS ONLY X AUTOSONLV No DadunNe SPPI81817800 1112312023 11/2312024 MBI tlEeDISINGLE LIMIT (CEO S 1,000,000 X BODILY INJURY Per arson E X BODILY INJURY Per accitlenl $ P®Oal IMAGE E X A umRELLA LMB EXCESS Me X OCCUR CLAMS -MADE BTN2481652 6/2612024 612fil2025 EACH OCCURRENCE $ 2,000,000 X AGGREGATES 2,000,000 X I DEO I I RETENTIONS O Over GL S WC C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER,UECUTIVE ❑ `MiiMrtory In NEHj EXCLUDED9 'Yes. tles site uneer DESCRIPTION OF OPERATIONS taSmv NIA 7600005937241 10/112024 10/1I202$ X PER OTH- E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 11000,000' E.L. DISEASE - POLICY LIMIT 1,000,000 D Leased/Rented -t 6606072C693 111112024 1111/2025 LeasediRented 500,000 DES CRIPTIONOFOPERATIONSILOCATIONSIVEHICLES (ACORDlei,AtldHional Remarks ScMduM,may4aeachetlNmoreapacebre uire I RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. As^UUTH�RDED REPRESENTATIVE H^ "~ ACORD 25 (2016103) © 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Or anization s Locations Of Covered Operations s Requlre By ritten Contract, Fully As Requlre By Written Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work 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. 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. CG 2010 0413 © Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 TRISC(1"2 DNIELSEN I T '4 CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDD _ n l3O2O24 l 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 C CT Diane Nielsen Nw HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite201 RECEIVED Ertl: (760) 00 4742 , NB:(760) 200-9706 R5iin'e—.nielsen@hubinternational.com �.drone.nielsen@hubinternational.com elsen Palm Desert, CA 92211 INSURER S AFFORDING COVERAGE NAIC f INSURER A: United Specialty Insurance Company 12537 HISIOUD INSURERB:Security National Insurance Company 19879 INSf/URERC:Everest Premier Insurance Company 16046 Tri-Star contracting II, Inc. Telar, Inc. 15-501 Little Morongo �FICE OF THE CITY CL pA fl,,,D:raveersro a Travelers PCasualty Company of America 25674 — INSURER E: Desert Hot Springs, CA 92240 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 DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU13JECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'TRA T',PEOFINSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY UP LIMITS X COMMERCIAL GENERAL UAMUTY CLAIMS -MADE X OCCUR $5,000 Deductible X XfEa TN2488856 6/26/2024 6/26/2025 URRENCE $ 1,000,000 RENTED occurtasr SD,000 f X ny_c rson 6,00&ADV INJURY r 1,000,000GENLAGGREGATE LgIMpITAPPUES PER: ❑X %& LOC GGREGATE 2,000,000POLICY -COMPX)P AGG $ 2,000,000OTHER:B AUTOMOBILELIABILITY X ANY AUTO AUTOS ONLY UUTTA ��pI�w�wNN��Dpp X A�T0.5 ONLY X AUTO IXJLV X NB Deductible X X SPP1181817800 11/2312023 11/2312024 dISINGLE LIMIT f 1,000,000 BODILY INJURY Per anon f BODILY INJURY PeractiOeM f PPe�aPEm.Rideilt AMAGE $ A UMEN IlA LIAO EXCESS LIAB X OCCUR CLaMS41ADE BTN2481652 6126/2024 6126/2025 EACH OCCURRENCE 2,000,000 X AGGREGATE 2,000,000 X I DED I I RETENTION$ 0 Over GL 8 WC C WORMERS COMPENSATIONOTFi- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER,EXECUTIVE Y� WQ�.F'CERrtAEEMggEER EXCLUDED9 IMaMatoryin NHl If yes, describe under DESCRIPTION OF OPERATIONS below NIA X 7600005937241 10/1/2024 101112025 TAT TE E.L. EACH ACCIDENT 1,000,000 S EL DISEASE -EA EMPLOYE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 D Leased/Rented 6606072C693 1/11/2024 1I11/2025 'Leased/Rented 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be atlached a moreapac� la required The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG2018 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 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 J ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: • S P P 181817800 COMMERCIAL AUTO CA9901870715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement. A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item 1. Who is an Insured of Paragraph A. Coverage under SECTION 11— COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180°i day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "insured°, but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION 11—COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply If the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. ToWing,'of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION 111 — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE Is amended to read; a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION 111. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to _the following conditions: a. We will provide "downtime loss" beginning on the 5" day after we have given you our agreement to pay for repairs to a covered "auto and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur. (1) You have a spare or reserve 'auto" available to you to continue your operations. (2) You pufchase a replacement "auto". (3) Repairs to your covered "auto have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade. Ill. PHYSICAL DAMAGE COVERAGE, is e. "Loss" caused, by theft, unless there is amended to add:. evidence of forced entry into the We will pay any resulting rental covered'auto° and a police report is reimbursement expenses incurred by you for filed. a rental of an "auto" because of 'loss' to a K. Accidental Alrbag Discharge Coverage covered 'auto' up to a maximum of $100 per day, for a maximum of 30 days for the same Item 3.a. of Paragraph B. Exclusions under a physical damage "loss', subject to the SECTION III PHYSICAL DAMAGE COVERAGE is amended to read: following conditions: a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical incurred during the policy period "loss° or electrical breakdown. The exclusion relating to mechanical beginning 24 hours after the and ending, regardless of the policy break -down does not apply to the expiration, with the number of days accidental discharge of an air bag. reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto". If the "loss° is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered "auto" and return it to you or the number of days it takes for the claim to If a covered 'auto' is owned or leased and be settled, whichever comes first. 9 we provide Physical Damage Coverage on it, we will pay, in the event of a covered b. Our payment is limited to necessary and P y ry total 'loss', any unpaid amount due on the actual expenses incurred. lease or loan for a covered 'auto , less: c. This -coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos' Damage Coverage Section of the available to you for your operations. policy; and d. If a "loss' results from the total theft of a b. Any: covered "auto° of the private passenger (1) Overdue lease or loan type, we will pay under this coverage only that amount of your rental payments including penalties, reimbursement expenses which is not Interest or other charges already provided for under the Physical resulting from overdue Damage Coverage Extension. payments at the time of the °loss°; J. "Personal Effects" Exclusion (2) Financial penalties imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III —PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss" to "personal Credit Life Insurance, Health, effects' of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and b. Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" Involved in the same "loss", only one deductible will apply to that 'loss'. If the deductible amounts vary by "autos", P. then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first 'loss" reported during the corresponding policy period: Loss Free Policy Periods with the Expansion Endorsement Deductible Reduction on the first"loss" 1 0% 2 26°% 3 50°% 4 75"% 6 100% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim,'suit" or'loss° is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer' or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your insurance manager; or (6) Your legal representative. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 6. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an 'accident" or "loss to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. Insurance is Primary and Noncontributory Subpart a. of Item 6. Other Insurance of Paragraph B. General Conditions under SECTION IV —BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item S..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto'that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV— BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not Intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total 'loss'. "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or Incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Or anization s Locations Of Covered O erations As Require y ritten Contract, Fully As Required By ntten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — 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. 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. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Pagel 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER ATN2488856 CONDVIERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" ansmg out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the products - completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section HI —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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of I POLICY NUMBER• ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Pagel of 1 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Organization: in Contract, Fully Executed PdorTo The Named Insured's Work 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 we may have against the person -or organization -shown -in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 Policy # ATN2488856 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART,and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional -insured -is a Named_Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the speciflcproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this Insurance: (i) apply on a primary and non-contributory basis; and (it) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Or anization s As Required By Written Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/1 /24 Policy No.7600005937241 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Insurance Company: Everest Premier Insuranc- �• - Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. Premium $ INCL. TRISCON-02 CERTIFICATE OF LIABILITY INSURANCE I DATE I(MMID^ IYYY) 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 endorsements . PRODUCER License # 0757776 rigA T Diane Nielsen Palm Desert, CA 92211 INSURED Services Inc. Tri-Star Contracting 11, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 360-4700 4742 COVFRAr;FS 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 I TYPE OF INSUMNCE ADDL INMM SUB POLICY NUMBER POLICY EFF POLICY EXP DMnS A I X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR $5,000 Deductible X X TN2488856 6/2612024 6/26/2025 EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTED (Ea commence) 50,00PREMISES X MED EXP (Any one Noom 5,000 PERSONAL B ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC 11 OTHER: GENERAL AGGREGATE E 2,OOQ000 PRODUCTS - COMPIOP AGG E 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AIUIppT��O��S ONLY AUTOS X AUTOS ONLY X 00S ONLY X No Deductible X X SPPIS1817800 1112312023 11123/2024 COMBINED SINGLE LIMIT IEa accident) E 1,000,000 BODILY INJURY Per E BODILY INJURY Peraccident BODILY S OPaEwR�t AMAGE E A UMBRELLA LIAR EXCESS LAB X OCCUR CLAIMS -MADE STN2481662 6/2612024 6/26/2025 EACH OCCURRENCE S 2,000,000 X AGGREGATE 2,000,000 X I DEO RETENTIONS D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AoNY PROPREIETgO�Rq/PARTNERMXECUTNE YIN 'MFa[CE in NH)EXCLUDED? IM 1 NN) If yes, clesaibe under DESCRIPTION OF OPERATIONS bekn NIA X 7600005937231 101112023 10/1/2024 X I PER STATUTE OTM- E L. EACH ACCIDENT E 1,000,000 E.L. DISEASE - EA EMPLOYE f 110001000 E.L. DISEASE -POLICY LIMIT 1,000,000 D Leased/Rented 6606072C693 1111/2024 111112025 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may he attached R more space is mqulred) The City of Palm Springs, its officials, employees and agents are named as additional Insured per attached CG2010 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice Will be given to the certificate holder should any of the above policies be cancelled before the expiration^tCi` ay notice applies for non payment of premium REC Y E AN Z 4 2024 CFRTIFICATF WEII nFR CANCFI I ATiON OFFICE OF THE CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Palm Springs CityACCORDANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORIZEDREPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:, SPP181817800 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement. A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item 1. Who is an Insured of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 1800' day after you acquire or form the organization or the end of the policy period, whichever is earlier, (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or If similar insurance would have been available but for its termination or the exhaustion of its limits of Insurance. This insurance does not apply 9 coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "insured°, but only with respect to liability created in whole or part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply If the "bodily injury' results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CAS90187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limlted Automatic Towing Coverage Item 2. T&dng, of Paragraph A. Coverage, under SECTION III — POY51CAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and, labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss', for that covered 'auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss' expenses you sustain as a result of a covered physical damage "loss" to a covered "auto up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: - a. We will provide "downtime loss" beginning on the 5' day after we have given you our agreement to pay for repairs to a covered "auto and you have given the repair facility your authorization to make repairs; b. Coverage far "downtime loss" expenses will end when any of the following occur. (1) You have a spare or reserve 'auto" available to you to continue your operations. (2) You purchase a replacement 'auto'. (3) Repairs to your covered "auto have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade. III. PHYSICAL DAMAGE COVERAGE, is e. "Loss" caused, by theft, unless there is amended to add:. evidence of forced entry into the We will pay any resulting -rental covered 'auto' and a police report is reimbursement expenses incurred by you for filed. a rental of an °auto' because of 'loss' to a K. Accidental Alrbag Discharge Coverage covered "auto" up to a maximum of $100 per Item 3.a, of Paragraph B. Exclusions under day, fora maximum of 30 days for the same SECTION III — PHYSICAL DAMAGE physical damage"loss', subject to the COVERAGE is amended to read: following conditions: a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical or electrical breakdown. The incurred during the policy period beginning 24 hours after the'loss' and exclusion relating to mechanical ending, regardless of the policy break -down does not apply to the expiration, with the number of days accidental discharge of an air bag. reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered °auto°. If the'loss is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered 'auto" and return it to you or the number of days It takes for the claim to If a covered 'auto' is owned or leased and be settled, whichever comes first. if we provide Physical Damage Coverage on it, we will pay, in the event of a covered b. Our payment is limited to necessary and total °loss°, any unpaid amount due on the actual expenses incurred. lease or loan for a covered "auto°, less: c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos" Damage Coverage Section of the available to you for your operations. policy; and d. If a'loss' results from the total theft of a b. Any: covered 'auto' of the private passenger 1 Overdue lease or loan type, we will pay under this coverage only that amount of your rental payments including penalties, reimbursement expenses which is not interest or other charges resulting from overdue already provided for under the Physical payments at the time of the Damage Coverage Extension. loss°; J. "Personal Effects" Exclusion (2) Financial penalties imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss' to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and b. Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III —PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss'. If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss'. N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductlble will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the flrst"loss" t oi" _2 25°% 3 50% A 75% 5 100% If we pay a Physical Damage 'loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM Wit not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident', claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, 'suit' or "loss" Is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) An "executive officer' or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an 'accident" or "loss' to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. insurance is Primary and Noncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item S..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV —BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the Inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured. "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income° means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or Incurred; and 2. Continuing normal operating expenses Incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NvC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/01/2023 Policy No. 7600005937231 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: i r = -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Or anization s Locations Of Covered Operations As Require y ntten Contract, Fully s equlre By ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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. 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 fumished 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. CG 2010 0413 0 Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown In Declarations. Of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 12 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION —PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Or Governmental Agency Or Subdivision Or Political Subdivision: Required By Written Contract, Fully Executed Prior To The Named Insured's Work I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section H — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the products - completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section HI —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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2012 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER• ATN2488856 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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" or "property damage" caused, in whole or in part, by .,your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Organization: :n Contract, Fully Executed Prior To The Named Insured's Work to 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 we may have.against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Policy # ATN2488856 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 05100 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: The Additionailhsured"is a Named -insured undersuch-otherinsurance and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the speciflcproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other Insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Or anization s As Required By Written Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02120) Page 1 of 1 TRISCON-02 ACOKO CERTIFICATE OF LIABILITY INSURANCE IDNIELSEN DAM(MMmDIYYYY) 6/1712024 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 endorsements . PRODUCER License # 0767776 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 Palm Desert, CA 92211 CDN ACT Diane Nielsen (VTNE., Eat): (760) 360-4700 4742 1 W, No:(760) 200-9706 MSS, diane.nielsen@hubintemational.com INSURERISI AFFORDING COVERAGE RAID INSURER A: United Specialty Insurance Company 12537 INSURED Tri-Star contracting e, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER B: Securtty National Insurance Company (Am T 19879 INSURER C: Everest Premier Insurance Company 16046 INsuRER o: Travelers Property Casualty Company of America 26674 INSURER E: INSURER F : Cr1V1=0A[SPS CFRTIFIr:ATF NI ISSRFR• RFVISION NIIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SUB pOLJCY NUMBER POLICY EFF POLICY UP LIMITS _LMA X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR $5,000 Deductible X TN2488856 6/2612024 6/26/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES lEa occurrence) $ 50,000 X NED EXP (Any we 5,000 PERSONALS ADV INJURY 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JECT OLOC OTHER', GENERAL AGGREGATE 2,000,000 PRODUCTS-COMPIOP AGG 2,000.000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLV X RUTOS OIJIY Deductible JXX SPP181817800 1112312023 11/23/2024 COMBINED SINGLE LIMIT $ 1,0001000 BODILY INJURY Per BODILY BOODILY INJURY Pere $ 40a� l AMAGENo A UMBRELLA UAB EXCESs me X OCCUR CLAIMS -MADE BTN2481652 6/2612024 6/2612025 EACH OCCURRENCE S 2,000,000 X AGGREGATE 21000,000 X DELI I I RETENTIONS O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIET01a)PARTNEWEXECUTNE Y❑ FILE ory In NHR EXCLUDED? ( I If yes. describe untie, DESCRIPTION OF OPERATIONS below N I A 600005937231 101112023 10/1/2024 X PER I STATUTE OTH- EL. EACH ACCIDENT 1,000,000 E.L. DISEASE -EA EMPLOYE S 1,000,000 E.L. DISEASE - POLICY UMn 1,000,000 p Leased/Rented TI 6606072C693 1MI12024 IM112025 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD IN, Additional Remarks Schedule, may be attached if more space is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA RECEIVED City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium JUN 'L y 2024 OFFICE OF THE CITY CLER CFRTIFICATF HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Palm Springs CityACCORDANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORED REPRESENTATIVE s4� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2488856 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 &101:1#11111114 Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered O erations s equire By ritten Contract, Fully As Require By ritten Contract, Ful y Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — 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 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. 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: 2. 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. 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 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. CG 2010 0413 ©Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 CONTRACT ABSTRACT 1 Original: Contract Change Order No. 1 Contract Company Name: Company Contact: Summary of Services: Contract Price: Funding Source: Contract Term: Tri-Star Contracting II, Inc. Laura Davenport, Office Manager Annual Traffic Calming Projects, FY 22-23, Eastgate Road speed cushions, CP 22-23 75,540.00 (including this CCO#1 for $19,601.00) Local Measure A funds To be determined by the Notice to Proceed Contract Administration Lead Department: Contract Administrator: Engineering Services Department Joel Montalvo/Francisco Jaime/Max Scheideman Contract Approvals City Manager Approval: Change Order No. 1: Agreement Number: October 13, 2022 TBD A9227 Contract Compliance Exhibits: Signatures: Insurance: Bonds: On file Attached On file On file Contract Prepared By: Engineering Services Department Submitted on: 11/16/2022 By: Vonda Teed DocuSign Envelope ID: 42DAEFAF-B893-4B71-8309-98D3E525E70A Page 1 of 2 CITY OF PALM SPRINGS CONTRACT CHANGE ORDER No. 1 CP 22-23 Annual Traffic Calming Contractor: Tri-Star Contracting II, Inc. Date: November 15, 2022 CONTRACT CHANGE ORDER SUMMARY There were two additional traffic calming projects, Sonora @ El Cielo and Mesquite @ Cerritos, that were to be done by the City of Palm Springs Streets Department. These two intersections will be converted to all-way stop controlled intersections, with all associated signage and striping. Currently, the Streets Department is working with limited staff during Parade/Festival season and their striping equipment is currently nonoperational. Given the time sensitive nature of installing these two traffic calming projects, Staff asked Tri-Star Contracting II, Inc. to provide a quote to stripe these two intersections. CONTRACT CHANGE ORDER COST Sonora @ El Cielo Task ID Description QTY Unit Unit Cost Total Cost 01 Ladder Style Crosswalk 1,640 SF $ 3.60 $ 5,904.00 02 Stop Bar, include removal of 2x existing stop bars 4 EA $ 182.00 $ 728.00 03 Stop Legend, includes removal of 2x existing stop legends 6 EA $ 518.00 $ 3,108.00 04 Left Turn Arrow (Type IV), to include removal of old arrow 4 EA $ 186.00 $ 744.00 Mesquite @ Cerritos Task ID Description QTY Unit Unit Cost Total Cost 01 Ladder Style Crosswalk 1,460 EA $ 3.60 $ 5,256.00 02 Stop Bar 3 EA $ 94.00 $ 282.00 03 Stop Legend 4 EA $ 323.00 $ 1,292.00 04 Left Turn Arrow (Type IV), to include removal of old arrow 2 EA $ 186.00 $ 372.00 05 Black background for North & South leg of Crosswalk 1,120 SF $ 1.50 $ 1,680.00 06 Lane Line (6"), to include removal of existing dash lines within crosswalk areas 50 LF $ 4.70 $ 235.00 Total Lump Sum Change Order Amount: $19,601.00 CHANGES TO CONTRACT TIME: There are no changes to the contract time. Source of Funds: Sufficient funds are available in Account No. 1343100-80000 TRAFCALM-MEAS A-ANNUAL. Summary of Costs: Original Contract Amount: $55,939.00 Construction Start Date: 11/29/2022 Previous Change Orders: This Change Order: 0.00 Previous Agreed Completion Date: 01/27/2022 This Change Order Amount: $19,601.00 Calendar Days Added: 0 Revised Contract Amount: $75,540.00 Revised Completion: 01/27/2022 DocuSign Envelope ID: 42DAEFAF-B893-4B71-8309-98D3E525E70A Page 2 of 2 I have received a copy of this Change Order and the above AGREED PRICES are acceptable to Contractor. Tri-Star Contracting II, Inc. Signature – Bryan Willis, President Date City of Palm Springs Recommended By: Joel Montalvo, City Engineer Date Approved By: Teresa Gallavan, Interim City Manager Date Attest By: Brenda Pree, City Clerk Date DocuSign Envelope ID: 42DAEFAF-B893-4B71-8309-98D3E525E70A 11/16/2022 11/16/2022 11/16/2022 11/16/2022 r TRISCON-02 QNIELSEN CERTIFICATE OF LIABILITY INSURANCE D121271202YY) 12127/2022 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(les) 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 endorsements . PRODUCER License It 0757776 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite201 Palm Desert, CA 92211 9ROPITDiane Nielsen P"o"E 760 200-9706 IAIC, No, Eat: (760) 3603700 4742 FAX Nog( ) JMES,diane.nielsen hubinternadonal.com INSURERS AFFORDING COVERAGE NAIC# INSURER A, United Specialty Insurance Company 12637 INSURED Tri-Star Contracting II, Inc. INSURERB:WescoInsurance Company 25011 INSURER c: Everest Premier Insurance Company16045 INSURERD:Travelers Property Casualty Company of America 25674 Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER E: INSURER F: TIFICATE NUMBER • REVISION NUMBER: COVERAGES CER 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 I TYPE OF INSURANCE ADDRED SUBR wvpPOLICY NUMBER POUCYEFF POIJCYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY E 1,000,000 CLAIMS -MADE ❑X OCCUR X X TN2262138 6/26/2022 6/26/2023 D 50,000 Anarson t E 5,000 PPERSONALJURY 1,000,000 GENLAGGREGATE LqIMpITAPPUES PER POLICY ❑X dECT �LOC TE 2,000,000 OP AGG 2,000,000 B OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me aoddwt)s 1,000,000 BODILY INJURY Pe arson ANY AUTO X X P1987680.00 11/2312022 11123/2023 BODILY INJURY Per accident E AUTOSONLY AICJTHNFIOS�yAUs,NN�EEDpp Ix AUTOS ONLY X AUOTOONLY PeOremiRr�t AMAGE A UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS4AADE BTN2268997 8/26I2022 BI28/2023 EACH OCCURRENCE 2,000,000 X AGGREGATE 2,000,000 DED I RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUDVE YIN WQ�n'SCERMtEMBEft EXCLUDED? (ManUatory In NH) NIA X 7600005937221 101112022 10/1/2023 TH- PER STATUTE OER X I E.L EACH ACCIDENT 1,000,000 E.L DISEASE - EA EMPLOY 1,000,00-0 E.L. DISEASE - POLICY DMIT 1,000,000 If yes, describe under D DESCRIPTION OF OPERATIONS below Equipment Floater 6606072C693 1111/2023 1/1112024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached xmom apace Is required) Job -Annual Traffic Calming Projects, FY 22-23 The Cityof Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413 and CG2037 0413 (GL) and Automobile. Insurance is primarylnon-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice Will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, City of Palm Springs DEC 2 9 2022 ACCORDANCE WITH THE POLICY P OVISIONSCE WILL BE DELIVERED IN 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hall Reception Desk AUTHORIZED REPRESENTATIVE n n� ACORD 25 (2016/03) v Taaa-zuTO rAA.utcu a.vnrvrw r rvn. nu r ryn.n ,a.00.r;... The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 Or anization s Location s Of Covered Operations s equire y rltten Contract, Fully s equire y rltten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section It — 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 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: 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: 2. 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. All work, including materials, parts or equipment fumished 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 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. CG 20 10 0413 ® Insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER* ATN22621 38 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #ATN2262138 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the speciflcproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. li b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. 7*M Required By Written Contract, Fully Executed Prior To The Named Insured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 POLICY NUMBER- WPP1987680-00 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply 0s modified by the endorsement. NewlAcquired or Formed e. An "employee" of yours is an "insured" y Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entities. "employee's" name, with your Item 1. Who is an Insured of Paragraph A. permission, while performing duties Coverage under SECTION II — COVERED related to the conduct of your business. AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%). will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180"' day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or In part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the 'insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you awn or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for Its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto' subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5" day after we have given you our agreement to pay for repairs to a covered 'auto* and you have given the repair facility your authorization to make repairs; b. Coverage for'downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission 1. Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto" because of "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss' and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto'. If the "loss' is caused by theft, this number of days is the number of days it takes to locate the covered "auto' and return it to you or the number of days it takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve 'autos" available to you for your operations. d. If a "loss" results from the total theft of a covered "auto' of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects' Exclusion Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Exclusion We will not pay for "loss" to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. d. Contraband or property in the course of illegal transportation or trade. e. "Loss" caused by theft, unless there is evidence of forced entry into the covered "auto" and a police report is filed. K. Accidental Airbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto' is owned or leased and if we provide Physical Damage Coverage on it, we will pay, In the event of a covered total "loss", any unpaid amount due on the lease or loan for a covered "auto', less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease or loan payments including penalties, Interest or other charges resulting from overdue payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) Security deposits not refunded by the lessor; and (6) Carry-over balances from previous loans or leases CA990187 0716 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered 'autos' involved in the same *loss", only one deductible will apply to that 'loss". If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first 'loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the first "loss" 1 0% 2 25% 3 50% 4 75% 6 100% If we pay a Physical Damage'loss' during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, 'suit" or "loss" is known to: (1) You, 0 you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your Insurance manager; or (6) Your legal representative. P. aiver Of Subrogation For Auto Liability osses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 6. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident' or "loss" to Impair them. However, if the Insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. surance is Primary and Q.Ooncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other Insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 5..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 6 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that Is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards Is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are Inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains In effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and Included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Pagel of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. MIN 1171711_" PERSON OR ORGANIZATION JOB ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/0112022 Policy No. 7600005937221 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. 41 --2,2-7 - A 6 4>yP TRISCON-02 DNIELSEN CERTIFICATE OF LIABILITY INSURANCE DATEIMMRDYYYY) 12127/2022 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(tes) 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 endorsements . PRODUCER License # 0757776 HUB International Insurance Services Inc. Suite 201 Gerald Ford Drive Suite Palm Desert, CA 92211 C NTACT Diane Nielsen FAX (McTNo, Evil: (760) 3604700 4742 , xo):(760) 200-6706 .diane.nielsen ubinternational.com INSURERS AFFORDING COVERAGE NAICa INSURER A: United Specialty Insurance Company 12537 _ INSURED Tri-Star Contracting II, Inc. INSURER B:WBSCOInsurance Company 25011 INSURER c:Everest Premier Insurance Com an 16045 INSURER D:Travelers Property Casualty Company of America 25674 Telar, Inc. 16-501 Little Morongo Road Desert Hot Springs, CA 92240 INSURER E: INSURER F: ...-.arm'n<�c all uaoco. REVISIr1NNUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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 iibm SUER POLICY NUMBER POLICY EFF MWDDrinr POLICY EXP umrrs A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEFAI OCCUR X TN2262138 6/26/2022 6126/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 50,00 MEDEXP A one rsor S 6,000 PERSONALS ADV INJURY s 1,000,000 GEN'L AGGREGATE LIRMpIT. APPLIES PER: POLICY � JECTEl LOC GENERAL AGGREGATE 2,OOD,000 PRODUCTS-COMPIOP AGG 2,000,000 COMBINED SINGLE LIMIT S S 1,000,000 B OTHER: AUTOMOBILE LIABILITY BODILY INJURY Per X ANr AUTO P1987680-00 11/2312022 11123/2023 BODILY INJURY Par ecadent S AUTOSDONLV ANUpT�EOSWVAL.�EDp X AUTOS ONLY X A O S'a Pei dent AMAGE S S A UMBRELLA DAB EXCESS LIAB X I OCCUR CLAIMS -MADE 13TN2268997 6/2612022 W2612023 EACH OCCURRENCE AGGREGATE DED RETENTIONSC WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN AOoFFICEOPRIIEMT9OERR/PARTNERIE ECUTIVE ❑ (ManAstory In NH)E.L NIA 7600006937221 10f112022 101112023 jt RTUT, AK EM E.L. EACH ACCIDENT DISEASE -EA EMPLOYII E.L. DISEASE - PODCV DMnD Leased/Rented yea, describe under DESCRIPTION OF OPERATIONS below Equipment Floater 8606072CS93 1/11/2023 1MI12024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACORD 101, Additional Remarks Schedule, my be atUched if more space is requiretl) RE: T75 W Chino Canyon Drive, Palm Springs, A The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice Will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEC 2 9 2022 ATHE EXPIRATION DATE THEREOF, NO CCORDANCE WITH THE POLICY PROVISIONSCE WILL BE DELIVERED IN City Hall AUTHORIZED REPRESENTATIVE Reception Desk a ACORD 25 (2016103) I000-<v r n�.�n'. ..a...�..'...'.......... ..n--- ---- The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Or onizetion s Location s Of Covered Operations s Requiredy rltten Contract, Fu y As equlre y ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work 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: 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. 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: 2. 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. 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 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. CG 2010 0413 0 Insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 @ insurance Services Office, Inc., 2012 CG 20 10 0413 �r9a-a-7 TRISCON-02 DN ELSEN �9nsWDDNY kft.� CERTIFICATE OF LIABILITY INSURANCE 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(les) 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 endorsemen s . PRODUCER License 1110757776 NC cT Diane Nielsen HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 ac°Nx ,Ex : (760) 36037004742 M6, No:f160 200-9706 Ms.,diane.nielsen hubintemabonal.com Palm Desert, CA 92211 INSURERISI AFFORDING COVERAGE NAIL/ INSURER A:United Specialty Insurance Company 12537 INSURED msuNER a: Ohio Casualty Insurance Company 24074 wsuNERc:Everest Premier Insurance Company 16045 Tri-Star contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road INSURER D:Travelers Property Casualty Company of America 25674 INSURER E: Desert Hot Springs, CA 92240 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. NOTNATHSTANDING 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 ADD SUB POLICY NUMBER PM%I EFF POLICY EXP Laers A X COMMERCIAL GENERAL LIABILITY clA1MS#MADE �X OCCUR X X ATN2262138 6126/2022 6126/2023 EACH OCCURRENCE f 1,000,000 DAMAGE TO RENTED PREMISES (Ea occumsmool 50,000 NED EXP (Any one 5,000 PERSONAL a ADV INJURY f 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: PODGYI •• M LOC OTHER: ECT GENERAL AGGREGATE 2,000,00O PRODUCTS-COMPJOPAGG 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEWLED AUTOS ONLY AUTOS AUTOS ONLY X AITfOS ONLY X X BA055813694 11123/2021 11123/2022 COMRINEDSINGLE LIMIT f 1,000,000 X BODILY INJURY Per BODILY BODILY INJURY Per S X PE nl AMAGE f A UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE BTN2268997 W2612022 6126/2023 EACH OCCURRENCE 2,000.000 X AGGREGATE 2,000.000 LIED I I RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILRY ANY PROPRIIET6OERR/PARTNERI ECUTNE MmWEto In NH E%CLUDEDt ( ry I N yes, 0eeal0e umxr DESCRIPTION OF OPERATIONS Iebe NIA X 7600006937221 1011/2022 1011/2023 X PER OTM- E.L EACH ACCIDENT 1,000,000 EL DISEASE -EA EMPLOY f 1,000,000 E.L DISEASE - POLICY LIMIT 1,000,000 D Equipment Floater 6606072C693 1/11/2022 1/11/2023 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IADORD 101, Additional Remarks SchWule, my W seaelmd If mom space Is re ulretl The City of Palm Spdngs, Its officials, employees and agents are named as additional insured per attached CG2018 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. LTn�nrr:�� 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration datRFJCAWWQd4Ie applies for non payment of premium OCT 0 4 2022 CERTIFICATE HOLDER CANCELLATION Office of the City Clarir SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs CE WILL BE DELIVERED IN THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE O POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUWORIZED REPRESENTATIVE NO� ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICYNUMBER: BA055813694 COMMERCIAL AUTO CA 24 04 08 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM We waive any right of recovery we may have against any additional insured under Section II — Liability Coverage, A. Coverage, 1. Who Is An Insured, c. because of payments we make for injury or damage, but only as respects loss aris- ing out of the operation, maintenance or use of a covered "auto" you own pursuant to the provisions of the "insured con- tract", written agreement, or permit. PI CA 24 04 08 07 (AutoWaiver) Includes copyright material of Page 1 of 1 Insurance Services Office, Inc POLICYNUMBER BA055813694 COMMERCIAL AUTO I CA 2010 05 07 (Blkt) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement Chances the nnUev affantiva nn the InmNlon date of the nnlim unlacq annthar data Lc Inr it tort h Wnw_ Endorsernpnt effective 11/23/18 Ohio Casualty Insurance Company Named Insured TO - StarContracting I I, Inc. Countersigned by j}I by j (Authorized Representative) WHO IS AN INSURED (under Section II —Liability Coverage, A.1) Is amended to Include as an'Insured'the person or organization shown In the Schedule, with respect to the operation, maintenance, or use of a covered 'auto' you own If: 1) You are obligated to add that person or organization; as an additional Insured to this policy by: a. an expressed provision of an 'Insured contrad", or written agreement; or b. an expressed condition of a written permit Issued to you by a governmental or public authority; and 2) The Rxodily lrgwy` or'property damage Is caused by an'accidenr which takes place after. a You executed the 'Insured contract" or written agreement; or b, The permit has been issued to you. Blanket as required by an expressed provision of an "insured contract", or written agreement; or an expressed Condition cf a written permit Issued to you by a governmental or publlc authority and eBecttve during the policy period as stated on the policy declarations. t pIfM2DlptbOP(B�Q Pop Idl POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 F'i�3:I�111�� Name Of Additional Insured Person(s) Or O anization s Locations Of Covered Operations s equire y ritten Contract, u y s equire y ntten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work 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. 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 fumished 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. CG 2010 0413 0 insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ® Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER•ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #ATN2262138 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART,and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured Is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Organization(s) As Requlred By Written Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (0220) Page 1 of 1 POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCT&COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGAMZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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:10/01 /2022 Policy No. 7600005937221 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium S INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual- 1999. File: 15104 (CA PVI C. r' I CIICrf\TPr' / � l )/ Notice Requested by and Return t St: I Ref. Num: JOINT CHECK REQUESTED Hi -Grade Materials Co. I Job Name: 17671 Bear Valley Road I Job No. Hesperia, CA 92345 1 Cert No. 760-244-9325 California Preliminary Notice ( Public and Private Work) See Civil Code Sections 8200, et sea.. 9300, et sea. This is not a Lien; This is not a reflection on the Inteerity of any contractor or subcontractor TO THE OWNER or PUBLIC ENTITY or reputed ownenprivate work) (public work) 1. the tollowing is a general description of the labor, service, City of Palm Springs equipment or materials furnished or to be furnished by the 3200 East Taquitz Canyon Way undersigned: Palm Springs, CA 92263 Ready Mix Concrete, Rock and Sand Miscellaneous Construction & Equipment Rentals 2. Estimated Price: $ $5,000.00 TO THE DIRECT CONTRACTOR Reputed Direct Contractor, Wary (private or public work) 3. The name of the person, who furnished that labor, service, Tri Star Contracting 15-501 Little Morongo Rd. Desert Hot Springs, CA 92240 LENDER (IF ANY) Reputed Lender, Wary No lender reported Band: Harco National Insurance Company 4200 Six Forks Road, Suite 1400 Raleigh NC 27609 equipment, or materials is: Hi -Grade Materials Co. 17671 Bear Valley Road Hesperia, CA 92345 4. The name of the person who contracted for purchase of that labor, service, equipment or material is: Tri Star Contracting 15-501 Little Morongo Rd. Desert Hot Springs, CA 92240 5. The description of the jobsite is: Mesquite and Cerritos Palm Springs, CA NOTICE TO PROPERTY OWNER EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR IN FULL, if the person or firm that has given you this notice is not paid in full for labor, service, equipment, or material provided or to be provided to your construction project, a lien may be placed on your property. Foreclosure of the lien may lead to loss of all or part of your property. You may wish to protect yourself against this by (1) requiring your contractor to provide signed release by the person or firm that has given you this notice before making payment to your contractor, or (2) any other method that is appropriate under the circumstances. This notice is required by law to be served by the undersigned as a statement of your legal rights. This notice is not intended to reflect upon the financial condition of the contractor or the person employed by you on the construction project If you record a notice of cessation or completion of your construction project, you must within 10 days after recording, send a copy of the notice of completion to your contractor and the person or firm that has given you this notice. The notice must be sent by registered or certified mail. Failure to send the notice will extend the deadline to record a claim of Iien.You are not required to send the notice if you are a residential homeowner of a dwelling containing four or fewer units. tme of my own knowledge. 1 declare under penalty of perjury that the foregoing is true and correct Executed at Hesperia, CA. On 1212712022 for Hi -Grade Materials Co. By: "-"�"�-'�--'�-- Nicole Falknor, Credit Assistant PROOF OF SERVICE BY MAIL AFFIDAVIT 1 declare that 1 served a copy of the above document, and any related documents, by (as required by law) first-class, certified or registered mail, RECEIVED postage prepaid, addressed to the above named parties, at the addresses listed above, on 12127 22 1 declare under penalty that the foregoing is true and correct. Executed at Haperia, California on 1212712022 , j A N 0 3 2023 By " —'Nicole Falknor, Credit Assistant City Hall Reception Desk TRISCON-02 DNIELSEN ACORO' CERTIFICATE OF LIABILITY INSURANCE �/ DATE (MM OD YYYY) 11/23/2022 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 endorsements . PRODUCER License # 0757776 c ^cT Diane Nielsen �HO ri, Enl: (760) 360d700 4742 , Nd (760 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite tot JMss,diane.nielsen hubintemational.com Palm Desert, CA 92211 INSURERSAFFORDING COVERAGE NAICM WSURIERAMiriked Specialty Insurance Company 12537 INSURED INSURERB:WescoInsurance Company 26011 INSURER c:Everest Premier Insurance Company 16045 Tri-Star Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road INSURERD:Travelers ProCasualty Com n of America 25674 Desert Hot Springs, CA 92240 INSURER E: WSURERF: COVFe&ncs CFRTIFIrATF NIIMRFR• 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. HIER TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR X X ATN2262138 6/26/2022 6/26/2023 EACH OCCURRENCE S 1,000,000 DMA TORE D 50,00g MED EXP (Any one xmx, 5,000 PERSONAL& ADV INJURY S 1,000,000 GEWL AGGREGATE LIMIT APPUES PER: POLICY �X JERCaT EI LOC OTJIGR GENERAL AGGREGATE 2,000,000 PRODUCTS- COMPIOP AGG S 2,000,000 S B AUTOMOSILELIABIUTY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS 0? X Al1TO50NLV X X PI987680-00 11123f2022 11/2312023 COMSINEO SINGLE LIMIT 1,000,000 BODILY INJURY Per S BODILY BODILY INJURY Per acddeM �OPER. Vnl AMAGE S A UMBRELLA UAB EXCEss Llue X OCCUR CINMS-0WDE STN2268997 6126/2022 6/2W2023 EACH OCCURRENCE $ 2,000,000 X AGGREGATE 2,000,000 LIED RETENr10NS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERMXECUTIVE YIN ooFFICEWMEM9ER EXCLUDED9 ,Mamfetory In NN) If yes, describe under DESCRIPTION OF OPERATIONS baba NIA X 7600005937221 1011/2022 1011/2023 X PER OTH. EL EACH ACCIDENT 110001000 E.L. gSEASE- FA EMPLOYE i,00D,0D0 EL DISEASE - POLICY UNIT 1,000,000 D Equipment Floater 6606072C693 1/11/2022 1/11/2023 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, AddRional Renurks Schedule, may be anached If Mrs space is "ulred The City of Palm Springs, its officials, employees and agents are named as additional insured. attached CG201 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days Written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEC 012022 City of Palm Springs ACCORDANCE WITH THE POLICY ROVISIO SCE WILL BE DELIVERED IN 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hail ReceptlOn Deek AUTHORIZE /D ��RR�EE/PP))R_�ES��ENTATIVE �4ra'r6��+ � ACORD 25 (2016/03) (9) 1988-z015 ACUHO cUHPUKA I RJN. AU ngnts reserveo. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Or anization s Location s Of Covered O erations s equire y rltten Contract, Fu y s equlre By ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — 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 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 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: 2. 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. 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 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown In the Declarations. A. Section 11 — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 ® Insurance Services Office, Inc., 2012 Pape 1 of 1 Policy #ATN2262138 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02/20) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART, and supersedes any provision to the contrary: Primary and Non-Contrlbutory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specific project that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Name Of Person(s) Or Organization(s) JAs Required By Written Contract, Fully Executed Prior To The Named Insured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 POLICY NUMBER- WPP1987680-00 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following. BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply modified by the endorsement. 0s y Acquired or Formed e. An "employee" of yours is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entities. "employee's" name, with your Item 1. Who is an Insured of Paragraph A. permission, while performing duties C ION II COVERED related to the conduct of your business. Coverage under SE T — AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%). will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180s' day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. f. Any person or organization you are required by written contract or agreement to name as an additional 'insured", but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 — COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 6. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" Is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement Is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto', for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss' to your'auto . F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 4B hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION 111. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 51h day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve"auto' available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto" because of "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto". If the "loss' is caused by theft, this number of days is the number of days it takes to locate the covered "auto' and return it to you or the number of days it takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve 'autos" available to you for your operations. d. If a "loss" results from the total theft of a covered "auto' of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects' Exclusion Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: 'Personal Effects' Exclusion We will not pay for "loss" to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. d. Contraband or property in the course of illegal transportation or trade. e. "Loss' caused by theft, unless there is evidence of forced entry into the covered 'auto" and a police report is filed. K. Accidental Alrbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto' is owned or leased and if we provide Physical Damage Coverage on it, we will pay, in the event of a covered total "loss", any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease or loan payments including penalties, Interest or other charges resulting from overdue payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) Security deposits not refunded by the lessor; and (6) Carry-over balances from previous loans or leases CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 6 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" Involved in the same 'loss", only one deductible will apply to that "loss'. If the deductible amounts vary by'autos', then only the highest applicable deductible will apply to that "loss'. N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the first "loss" 1 0% 2 25% 3 50% 4 75% 5 1 100% If we pay a Physical Damage "loss' during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, "suit" or "loss" is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) An "executive officer' or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your insurance manager; or (6) Your legal representative. P. aiver Of Subrogation For Auto Liability osses Assumed Under Insured Contract Item S. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 6. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or'loss" to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. surance is Primary and Q.d oncontributory Subpart a. of Item 6. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, it required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 6..0ther Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA9901B7 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss'. "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, Including payroll. In this endorsement, Headinas and Titles are Inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains In effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER ATN2262138 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule it 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 we may have against the person or organization shown in the Schedule above because of payments we make for Injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 13 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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:10/01 /2022 Insured: Tri-Star Contracting II, Inc. Policy No.7600005937221 Endorsement No.001 Premium S INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Imursuce Rating Bureau of California. All rights reserved. From the WCIRB's California Worken' Compensation Insurance Forms Manual - 1999. a 7 CALIFORNIA PRELIMINARY NOTICE *****PLEASE ISSUE JOINT CHECKS***** NOTICE IS HEREBY GIVEN that: ROBERTSON'S 200 S MAIN ST CORONA CA 92882 (951)685-2200 Has or will Furnish labor, services, equipment, or materials, generally described as: READY MIX CONCRETE, ROCK & SAND To be furnished or furnished for the building, structure or the work of improvement described as follows: INDIAN CYN DR & ROSA PARK PALM SPRINGS J.C.N. # 140731 Tract No. Lot No. Cert Num: 21183615 Name of Person or Firm who contracted for purchase of the labor, services, equipment, or materials is: ELECNOR BELCO ELECTRIC IN 14320 ALBERS WY CHINO CA 91710 An estimate of the total price of said labor, services, equipment or materials is: 19,029.84 NOTICE TO PROPERTY OWNER EVEN THOUGH YOU HAVE PAID YOUR CONTRACTOR IN FULL, if the person or firm that has given you this notice is not paid in full for labor, service, equipment, or material provided or to be provided to your construction project, a lien may be placed on your property, Foreclosure of the lien may lead to loss of all or part of your property. You may wish to protect yourself against this by (1) requiring your contractor to provide a signed release by the person or firm that has given you this notice before making payment to your contractor, or (2) any other method that is appropriate under the circumstances. This notice is required by law to be served by the undersigned as a statement of your legal rights. This notice is not intended to reflect upon the financial condition of the contractor or the person employed by you on the construction project. If you record a notice of cessation or completion of your construction project, you must within 10 days after recording, send a copy of the notice of completion to your contractor and the person or firm that has given you this notice. The notice must be sent by registered or certified mail. Failure to send the notice will extend the deadline to record a claim of lien. You are not required to send the notice if you are a residential homeowner of a dwelling containing four or fewer units. CIY�%�1 M;ii)H�9 i tlZi� i73i] �{Iq IIfIiI:pTll�[aSl CITY OF PALM SPRINGS 3200 E TAHQUITZ CANYON WY PALM SPRINGS CA 92262 LENDER OR REPUTED LENDER SUBCONTRACTOR with w hurt claimant ha: contracted USO NOTIFIED TEN �N f OR RONI11N(,. sc E'VT RECEIVED APR 0 3 2023 City Hall' Reception Desk TRUST FUNDS TO W HICH SUPPLEMENTAL FRINGE BENEFITS ARE PAYABLE Pit cif of Service This undersigned declares as follows: I am over the age of 18. and employed by Robertson's, whose business address is 200 South Main Street, Suite 200. Comma, California 92882. 1 am employed in the County of Riverside. where this mailing occurs. and not a party to this action. On the date shown below, in the City of Comma, I served the within California Preliminary Notice. sealed and deposited in the mail in the manner prescribed by law, by first class registered or certified mail, postage fully prepaid, to the persons) at the addresses shown thereon. KEM GOTZON Date: 03/29/2023 Name: ROBERTSON'S �.ti+ - USPOSTAGE-�w- P.O. BOX 3600 "►7'' CORONA, CA 92878-3600 �{: �� 000939994 0 4.75° 7108 1176 8852 1183 615_ IMPORTANT: CALIFORNIA PRELIMINARY NOTICE CITY OF PALM SPRINGS 3200 E TAHQUITZ CANYON WY PALM SPRINGS CA 92262 69441 140731 ' 7 ® � 1 ( / � � � 1 ZZ� DATE (MMIDD/YYVY) ACORO CERT :ATE OF LIABILITY INSURA E t 03/10/2023 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). CONTACT PRODUCER NAME: QUetha ROdr19UE2 Garcia Insurance Inc RECEIVED NCNNo Ea : (760) 320-1111 1 FAX Ne (760) 320-1115 2099 E. Tahquitz Canyon Way nooaless: MAR 15 2023 INSURER(S) AFFORDING COVERAGE NAICN Palm Springs CA 92262 INSURERA: Hudson Excess Insurance Co INSURED City Hall INSURER 8: NATIONWIDE 23787 Shasta Fire Protection, Inc. Reception D6* Insurance Company of the West INSURER C: P Y 72120 Northshore Street, #C INSURER D: INSURER E: Thousand Palms CA 92276 INSURER F: Cl1V9RAGFS y:FRTIFICATF NI IMRFR• CL2331007700 RFVISI0N NIIMRFR 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE INSD MD POLMYNUMBER MWDD/YYYY MWDD LIMITS COMMERCIALGENERALMMUL EACH OCCURRENCE S 1,000,000 CIAIMS-MADE ® OCCUR PREMISES Me cccumancel S 100,000 MEDEXP(AMenepenan) S 5,000 PERSONAL A ADV INJURY $ 1,000,000 A Y Y FSL000092-04 10/16/2022 10/16/2023 GENLAGGREGATE LIMITAPPUES PER. GENERALAGGREGATE S 2.000,000 POLICY ® JPER6 LOC PRODUCTS -COMP/OPAGG $ 2,000,000 Pollution Liability s INCLUDED OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BODILY INJURY per person) E ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS Y ACP3120062383 03/15/2023 03/15/2024 BODILY INJURY (Per accident) s PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Uninsured motorist E 1,000,000 UMBRELLA UAa OCCUR '-'-' "" " —""- "*."' FACH OCCURRENCE E 5,000,000 AGGREGATE S 5,000,000 A EXCESS LIAR CLAIMS -MADE FSL0000045-04 10/16/2022 10/16/2023 DEC RETENTION $ 10,000 S C• WORKERS COMPENSATION ANDEMPLOYERS'UABIUTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA Y WSD 500556212 01/01/2023 01/0,2024 PER OTH- ON STATUTE ER E.L. EACH ACCIDENT S 1,000.000 EL DISEASE - EA EMPLOYEE S 1,000,000 If yesdescnee under DESCRIPTION OF OPERATIONS Eel.E.L. DISEASE. POLICY LIMIT E 1,000,000 Errors & Omissions Aggregate $2.000.000 A FSL000092-04 10/16/2022 10/16/2023 Occurence $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addhional Remark, Schedule, may W attached it more space A nfulned) The City of Palm Springs, its officials, employees and agents are named as an additional insured This insurance is primary and non-contributory. Waiver of subrogation applies. *10 day notice of cancellation applies for non-payment of premium. *30 day written notice needed for cancellation of policy. I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Palm Springs ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E. Tahquitz Canyon Way AUTHORIZED REPRESENTATIVE Palm Springs CA 92262 I ��/- ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FSL000092-04 COMMERCIAL GENERAL LIABILITY C G 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations Blanket where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and Included in the "products -completed operations hazard". CG 20 37 07 04 !SO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: FSL000092-04 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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) Blanket where required by written contract 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) desig- nated above. will be shown in the B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 C3 POLICY NUMBER: FSL000092-04 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 6Yy:I�rP1�� Name Of Person Or Organization: Blanket where required by written contract. 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0 WORKERS COMPENSATION AN[ _ 3LOYERS LIABILITY INSURANCE POLIC . WC 99 06 34 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 otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER, CALIFORNIA OPERATIONS ONLY. 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA 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 Effective 01/01/2023 Policy No. WSD 5005562 12 Endorsement No. Insured SHASTA FIRE PROTECTION INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 6.00) INSURED COMMERCIAL AUTO AC 70 04 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO PROTECTION o PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A. Effect of This Endorsement B. Temporary Substitute Autos— Physical Damage Coverage C. Employees as Insureds— Nonowned Autos D. Additional Insured by Contract, Permit or Agreement E. Prejudgment Interest Coverage F. Personal Effects and Property of Others Extension G. Expanded Towing Coverage H. Expanded TransortatlonExpense I. Extra Expense— Stolen Autos J. Emergency Lockout K. Transfer Of Rights Of Recovery Against Others To Us L. Section IV — Business Auto Conditions - Notice of Knowledge of Occurrence AC 70 04 03 16 ACP BA 31AA062333 Includes copyrighted material of Insurance Services Office, Inc. with its permission LD40 21091 INSURED COPY AC7004031600 0001 Page 1 of 3 47 0012923 AC 70 04 0316 A. EFFECT OF THIS ENDORSEMENT Coverage provided under this policy is modified by the provisions of this endorsement. If there is any conflict between the provisions of this endorsement and the provision(s) of any state - specific endorsement also attached to this poli- cy, then the provision(s) of the state -specific endorsement shall apply Instead of the provi- sions of this endorsement that are in conflict, but only to the extent of the conflict, and only to the extent necessary to bring such provisions into conformance with the state requirement(s) contained in the provision(s) of the state -specific endorsement. B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE The following is added to paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of the - COVERED AUTOS SECTION: If Physical Damage Coverage Is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Physi- cal Damage Coverage: Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of Its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction The coverage that applies is the same as the coverage provided for the vehicle being replaced. C. EMPLOYEES AS INSUREDS - NONOWNED AUTOS The following is added to paragraph A.1. Who Is An Insured of SECTION II - COVERED AUTOS LIABILITY COVERAGE: d. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your per- sonal affairs. D. ADDITIONAL INSURED BY CONTRACT, PERMIT OR AGREEMENT or signed by you prior to a "bodily injury" or "property damage" occurrence Is an 'insured" for Covered Autos Liability Coverage. However, with respect to covered "autos", such person or organization is an insured only to the extent that person or organization qualifies as an "insured" under A.1. Who is an Insured of SECTION II - COVERED AUTOS LIABILITY COVERAGE. If specifically required by the written contract or agreement referenced in the paragraph above, any coverage provided by this en- dorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non-contributory with this insurance. If the written contract does not require this cov- erage to be primary and the additional in- sured's coverage to be non-contributory, then this Insurance will be excess over any other val- id and collectible insurance available to the ad- ditional insured. E. PREJUDGMENT INTEREST COVERAGE The following paragraph Is added to SECTION II - COVERED AUTOS LIABILITY COVERAGE, Supplementary Payments under Item: (7) Prejudgment interest awarded against the "Insured" on that part of the judgment we pay. If we make an offer to pay the appli- cable limit of Insurance, we will not pay any prejudgment Interest based on that period of time after the offer. F. PERSONAL EFFECTS AND PROPERTY OF OTHERS EXTENSION 1. The. Care, Custody or Control Exclusion of the SECTION II - COVERED AUTOS LIABILITY COVERAGE, does not apply to "property damage" to property, other than your property, up to an amount not exceed- ing $250 in any one "accident". Coverage Is excess over any other valid and collectible insurance. 2. The following paragraph Is added to. Cover- age Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE: c. We will pay up to $500 for your property that is lost or damaged as a result of a covered "loss", without applying a de- ductible. Coverage is excess over any other valid and collectible insurance. The following is added to A.1. Who Is An G. EXPANDED TOWING COVERAGE Insured of SECTION 11 - COVERED AUTOS 1. We will pay up to: LIABILITY COVERAGE: a. $100 for a covered "auto" you own of Any person or organization that you are the private passengertype, or required to name as an additional insured in a written contract or agreement that is executed Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc. AC 70 04 03 16 with its permission ACP BA 31-0-0062383 LD4D 21091 INSURED COPY AC7004031600 0001 47 0012924 AC 70 04 0316 b. $250 for a covered "auto" you own that or stolen and you have changed the is not of the private passengertype, lock to prevent an unauthorized entry; and for towing and labor costs Incurred each 3. Original copies of receipts for services of time the covered "auto" is disabled. a locksmith must be provided before However, the labor must be performed at reimbursement is payable. the place of disablement. 2. This coverage applies only for an "auto" covered on this policy for Comprehensive or Specified Causes of Loss Coverage and Collision Coverages. 3. Payment applies In addition to the otherwise applicable amount of each coverage you have on a covered "auto'. H. EXPANDED TRANSPORTATION EXPENSE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE SECTION is replaced by the following: We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense In- curred by you because of the total theft of a covered "auto" of the private passenger type. We will only pay for those covered "autos" for which you carry Comprehensive or Specified Causes of Loss Coverage. We will pay for tem- porary transportation expenses Incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss" I. EXTRA EXPENSE — STOLEN AUTOS The following paragraph is added to Coverage Extensions. of SECTION III — PHYSICAL DAMAGE COVERAGE: c. We will pay for up to $5,000 for the expense of returning a stolen covered "auto" to you. We will pay only for those covered "autos" for which you carry Comprehensive or Spec- ified Causes of Loss Coverage J. EMERGENCY LOCKOUT — PRIVATE PASSENGER VEHICLES We will reimburse you up to $75 for reasonable expense incurred for the services of a locksmith to gain entry into your covered "auto" of the pri- vate passenger type subject to these provisions: 1. Your door key or key entry pad has been lost, stolen or locked in your covered "auto" and you are unable to enter such "auto", or 2. Your key or key entry pad has been lost K. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US The following is added to the Transfer Of Rights Of RecoveryAgainst Others To Us Condition: We waive any right of recovery we may have against any person or organization to the extent required of you by a written con- tract executed prior to any "accident" be- cause of payments we make for damages under this coverage form. L. NOTICE OF AND KNOWLEDGE OF OCCURRENCE SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A is amended as follows: 6. NOTICE OF AND KNOWLEDGE OF OCCURRENCE a. Your obligation In the Duties In the Event of Accident, Claim, Suit or Loss Condi- tion relative to notification require- ments applies only when the *accident" or 'loss' is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or Insurance manager, if you are a corporation. b. Your obligation in the. Duties in the Event of Accident, Claim, Suit or Loss Condition relative to providing us with documents concerning a claim or "suit" will not be considered breached unless the breach occurs after such claim or 'suit" is known to: (1) You, If you are an individual; (2) A partner, If you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, If you are a corporation. AC 70 04 03 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 3 with its permission ACP BA 31.M062383 L04D 21091 INSURED COPY ACT004031600 0001 47 0012925 /-- III TRISCON-02 CMAY sa` O�KO., CERTIFICATE OF LIABILITY INSURANCE M FDA612612023 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 pollcy(les) 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 endomement(s). PRODUCER License1110757776 N N .CT Diane Nielsen PAHcNNEo, E:r:(760) 36047004742 FAX ,No:(760)200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 .diane.nielsen hubinternational.com Palm Desert, CA 92211 INSURE 3 AFFORDING COVERAGE NAIOR INSURERA: United Speclafty Insurance Company 12537 INSURED INSURER B:WOSC_OInsurance Company 25011 TriStar Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road INSURER C: EVereert Prom ler Insurance Company 16045 INSURER D:Travelers Property Casualty Company of America 26674 INSURER E: Desert Hot Springs, CA 92240 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. WSR TYPE OF INSURANCE ADDL SUBR ppLICy NUMBER POLICY EFF MM/��Yll'EYYV LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR $5,000 Deductible X X TN2376531 6126/2023 6126/2024 EACH OCCURRENCE $ 1,000,006 DAMAGE TO RENTED PREMISES IF, ocomerical I 50,000 X MEDEXP An me 5,000 PERSONAL a ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �JEL`T DOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMPIOP AGG 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUU�TNNO.pSSWµ�}N� pp AUTOS ONLY X AUTOSOa X X P1987680-00 11/2312022 11/23/2023 COMBINED SINGLE LIMIT 11000,000 X BODILY INJURY Per Persoro $ BODILY INJURY Per acoderd $ X .P= AMAGE $ A X UMBRELLALIAB EXCESS UAB X OCCUR CLAIMS -MADE BTN2370408 612612023 6/2612024 RENCE $ 2, 000,000 2,0001000 DEC) RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER,EXECUTIVE YIN OFFICERrtdF1MtW EXCLUOEDi andamry n I ee,de scribe under OF OPERATIONS below NIA X 7600005937221 1011/2022 10/1/2023 OTH- ER RDENWT DENT 1,000,000 EA EMPLOYEIt 1,000,000 -POLICY LIMIT 1,000,000DESCRIPTION S D Equipment Floater 6606072C693 1/1112023 111112024 LeasedlRented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may M amcW K more space Is mqulred The City of Palm Springs, its officials, employees and agents are named as additional insured. attached CG201 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/non-contributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium CERTIFICATE HOLDER CANCELLATION RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs J U N 2 9 2023 THE EXPIRATION DATE THEREOF,TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICYPROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hall AUTHORIZED REPRESENTATIVE Reception Desk 'F3"",� ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TRISCON-02 CMA (MmmCERTIFICATE DpTE 6/26/2023 1 OF LIABILITY INSURANCE 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 If 0757776 c CT Diane Nielsen HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite201 PHONE Fpx (A?:, No, EXt): (760) 360-4700 4742 AX; No:(760) 200-9706 W.&S..diane.nielsen hubintemational.com Palm Desert, CA 92211 INSURERS AFFORDING COVERAGE NAICk INSURERA:United Specialty Insurance Company 12537 INSURED INSURER a:WBSCOInsurance Company 26011 INSURER C: Everest Premier Insurance Company 16045 Tri-Star contracting II, Inc. Telar, Inc. 15.501 Little Morongo Road INSURER D:Travelers Property Casualty Company of Amen" 25674 INSURERS: Desert Hot Springs, CA 92240 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 ADDLSUSR POLICY NUMBER POUCYEFF POLICY UPLTR UNITS A X CO MMERCIALGENERAL111181LITY CLAIMS -MADE ❑X OCCUR $5,000 Deductible ATN2376531 612612023 6126/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea 50,000 X MED EXP An one raon 5,000 E PERSONAL S ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT- APPLIES PER: POLICY [X]JEC'oT LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOP AGG 2,000,000 $ B AUTOMOBILE LIAeILITY ANV AUTO AUTOSONLY AUTOS SCHEDULED AUTOS ONLY X AUTOS ONLY PP1987680-00 11/23/2022 1112312023 COMBINED SINGLE LIMB drdiJx S 1,000,000 BODILY INJURY Per rson $ BODILY INJURY Per acddent $ er acEaaenl AMAGE $ $ A X UM8RELLAU,U3 EXCESS IJAe X OCCUR I CLAIMS -MADE BTN2370408 6/26/2023 612612024 EACH OCCURRENCE S 2,000,006 AGGREGATE S 2,000,000 DED I I RETENTION$ $ C IMDRXERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETgOERRARTNER,EXECUTIVE YIN **F�FIGERIMJn NHR EXCLUDED? ❑ (Mandsto NN Mae, describe under DESCRIPTION OF OPERATIONS below NIA 600005937221 1011/2022 1011/2023 H- E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE -EA EMPLOYE 1,DDD,DDD E.L. DISEASE- POUCY UNIT $ 1,000,000 D Equipment Floater 6606072C693 1/1112023 1/11/2024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be adached If more space is required) Job -Indian Avenue South of Garnet CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Springs s 9 Cityof Palm S 3200 E Tahquitz Canyon Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs, CA 92262 AUTHORMED REPRESENTAME AI�i�L/r7L� ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .�� TRISCON-02 CMA DAT12612 D/YYYV) 626/2023 ,4coRo' CERTIFICATEOF LIABILITY INSURANCE 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 1f 0757776 N�1ATA T Diane Nielsen HUB International Insurance Services Inc. 76030 Gerald Ford Drive Suite 201 la"ico,"No, Ea : (760) 360-4700 4742 , No:(760) 200.9706 Jaiss, diane.nisisen@hubintemational.com Palm Desert, CA 92211 INSURE S AFFORDING COVERAGE NAILS INSURERA: United Specialty Insurance Company 12537 INSURED INSURER B:We8COInsurance Company 25011 Tri-Star Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road INSURER C: Everest Premier Insurance Company 16045 INSURER D :Travelers Props CasualtyCompany of America 25674 INSURER E Desert Hot Springs, CA 92240 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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. INBR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER POLICY EFF POLICY UPLTR IbmB A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FVOCCUR $5,000 Deductible ATN2376531 6/2612023 6/26/2024 EACH OCCURRENCE E 1,000,000 OHMAGE( RENTED PREMISES 50,00p X MED EXP An one arson 5,000 E PERSONAL S ADV INJURY S 1,000,000 POLICY 1XI PP& LOC OTHER: ,IL GENERALAGGREGATE E 2,000,000 PRODUCTS - COMPIOP AGG E 2,000,000 E B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS SSWNEp AUTOS ONLY X AUTOS ONLY PP1987680-00 11123/2022 1112312023 COMBINED SINGLE LIMIT £ 11000,000 X BODILY INJURY Per E BODILY INJURY Per accident E X PPeOe uRtlent AMAGE E A X UMBRELLA LAB EXCESS LIAB X OCCUR CLAIMS4tADE BTN2370408 6/26/2023 6/26/2024 EACH OCCURRENCE 2,000,000 AGGREGATE E 2,000,000 DED I I RETENTIONS S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPREIETgO�RprPARTNER,FJ(ECUTIVE Y❑ IN ( MFanEatin NN) EXCLUDED'! It desm1pe under DESCRIPTION OF OPERATIONS hHow NIA 7600005937221 101112022 1011/2023 )( PER OTF4 E.L. EACH ACCIDENT 11000,000 E.L. DISEASE - EA EMPLOYE 1,000,000 E.L. DISEASE- POLICY LIMIT 1,000,000 E D Equipment Floater 6606072C693 1/11/2023 111112024 Leased/Rented 260,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, my Ire attached If more space Is requiredl Job -Gene Autry Trail Repair, North of E Via Escuela CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Palm Springs CE WILL BE DELIVERED IN THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE OL CV PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 AUTHORD EEOGREEPPPRREESSE�NTATIVE ACORD 25 (2016/03) ©1988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TRISCON-02 CMAYO 1 '4� CERTIFICATE OF LIABILITY INSURANCE DA6126120TE 23 YI 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 endorsements . PRODUCER License # 0757776 c CT Diane Nielsen HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 jnlcoNE , EXI : (760) 360d700 4742 FAX No :(760) 200-9706 E ' ,,diane.nielsen@hubinternational.com Palm Desert, CA 92211 INSURE $ AFFORDING COVERAGE NAICI INSURERA: United Specialty Insurance Company12b37 INSURED INSURER B:WeSCOInsurance Company 25011 INSURERC: Everest Premier Insurance Company16045 Tri-Star Contracting II, Inc. Toler, Inc. 15.501 Little Morongo Road INSURER D: Travelers PropertyCasual Companyof America 25674 INSURER E: Desert Hot Springs, CA 92240 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 CONTRACTOR 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. LIIL TYPE OF INSURANCE am SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL INABILITY CLAIMS -MADE ❑X OCCUR $5,000 Deductible ATN2376531 6126/2023 6/2612024 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES IF, occ,emmal 50,000 X MED EXP JAny one mon) 5,000 PERSONAL B ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑X JEC'T LOC OTHER: GENERAL AGGREGATE S 2,000,006 PRODUCTS -COMPIOP AGG S 2,000,000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED A�L�pTEEO��S ONLY AUTOS WNEO AUTOS ONLY X AUTOB ONLY PPI987680-00 11/23/2022 11/23/2023 COMBINED SINGLE LIMIT S 1,000,006 X BODILY INJURY Per oeewm $ BODILY INJURY Per aocm,rd $ X AOPER ent AMAGE $ S A X UMBRELLALIAB EXCESS LUAe X OCCUR CLAIMS -MADE BTN2370408 6/2612023 6/26/2024 EACH OCCURRENCE $ 2,000,000 AGGREGATE S 2,000,000 DELI I I RETENTIONS S C WORKERS COMPENSATION AND EMPLOYERS' UJURLRY Y I N ANY PROPREIETgO�RpIPARTNER/EXECUNVE ❑ laNFIGE yIrM1NH) EXCLUDED? Ixu I NN) H yes. describe under DESCRIPTION OF OPERATIONS below NIA 7600005937221 101112022 10/112023 X PER OISTATUTE RH- LL EACH ACCIDENT S 11000,000 EL. DISEASE - EA EMPLOYE 1,000,000 S E.L. DISEASE -POLICY LIMIT 1,000,000 $ D Equipment Floater 6606072C693 11/1112023 1111/2024 Leased/Rented 250,000 DESCRIPTIONOFOPERANONSILOCATONSIVEHICLES (ACORO 101, Addhbnal Remarks Schedule, may be attached if mom space is required) Project No. 21.17, Arnico Street Sewer Improvements Project - Phase 4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityOf Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 East Tahquitz Canyon Way Palm Springs, CA 92262 A�^U1THORIZE/D REPRESENTATIVE ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TRISCON-02 C A CERTIFICATE OF LIABILITY INSURANCE DATE2612023 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 endomement(s). PRODUCER License # 0757776 C NTACT Diane Nielsen HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite201 PHONE HO lio, Ext): (760) 360d700 4742 FAX 760 200-9706 IAA:, Nny.( ) Effio'L .diane.nielsen hubintemational.com Palm Desert, CA 92211 INSURE S AFFORDING COVERAGE NAICI INSURERA: United Specialty Insurance Company 12537 INSURED INSURER B:We$COInsurance Company 25011 INSURER C: Everest Premier Insurance Company 16045 Tri-Star Contracting 11, Inc. Telar, Inc. 15-501 Little Morongo Road INSURER D:Travelem Property Casualty Company ofAmerica 25674 INSURER E: Desert Hot Springs, CA 92240 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 WMICH 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. 'NSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF PODCYEXP LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR $5,000 Deductible X TN2376631 6/2612023 6126/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Me oewmmmi f 50,000 1( MED EXP An one raan $ 5,000 PERSONAL a ADV INJURY 1,000,000 GEN'L AGGREGATE UqMIT APPLIES PER POLICY [XI Ter LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS -COMPIOP AGG S 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUU�TNNO.pSSWwNNEE❑p AUTOS ONLY X AUTO VIN PP1987680-00 11123/2022 11/2312023 COMBINED SINGLE LIMIT 11000,000 BODILY INJURY Per S Ix BODILY INJURY Per a=sxm PerOPerEcitlent IMAGE f f A X UMBRELLA DAB EXCESS UAS X OCCUR CLAIMS -MADE BTN2370408 W26/2023 6/26/2024 EACH OCCURRENCE f 2,000,000 AGGREGATE f 2,000,000 DELI I I RETENTIONS S C WORKERS COMPENSATION AND EMPLOYERS' W1&DTY ANY PROPRIIETgO�RRIPARTNER/EXECUTIVE YIN IMaFIISMgl ry In NH) EXCLUDED? Ha tleaodbe order DESCRIPTION OF OPERATIONSW. NIA 600005937221 10/1/2022 10/1/2023 j( PER OTH- TAT T R E.L. EACH ACCIDENT 3 1,000,000 E.L. DISEASE -EA EMPLOYE 1,000,000 EL. DISEASE -POUCY UNIT S 1,000,000 D Equipment Floater 6606072C693 1/11/2023 1/11/2024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 11ACORD 101, AddWonal Remarks ScM uN, may Ee anacMd K more apace is required) RE: 775 W Chino Canyon Drive, Palm Springs, CA The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium CERTIFICATE HOLDER RF(`Ftrimn CANCELLATION CI of Palm Springs CityACCORDANCE J I N 9 Z�LJ lJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 City Hall Reception Desk AUTHORRED REPRESENTATIVE 44� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER ATN2376531 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Or anization s Locations Of Covered Operations s equlre y ntten Contract, Fully s equire By ritten Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section 11 — 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 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 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: 2. 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. equipment fumished 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 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. CG 2010 04 13 © Insurance Services Office, Inc., 2012 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER- WPP1987680-00 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply 0s modified by the endorsement. Newly Acquired or Formed e. An "employee" of yours is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entities. "employee's" name, with your Item 1. Who is an Insured of Paragraph A. permission, while performing duties Coverage under SECTION 11— COVERED related to the conduct of your business. AUTOS LIABILITY COVERAGE Is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180s day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION 11 —COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 6. Fellow Employee of Paragraph B. Exclusions under SECTION 11—COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 6 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident. No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5`h day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto' available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade. III. PHYSICAL DAMAGE COVERAGE, Is e. "Loss" caused by theft, unless there is amended to add: evidence of forced entry into the We will pay any resulting rental covered "auto' and a police report is reimbursement expenses incurred by you for filed. a rental of an "auto' because of "loss" to a K. Accidental Alrbag Discharge Coverage covered "auto" up to a maximum of $100 per Item 3.a. of Paragraph B. Exclusions under day, for a maximum of 30 days for the same SECTION III — PHYSICAL DAMAGE physical damage "loss", subject to the COVERAGE is amended to read: following conditions: a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical Incurred during the policy period "loss" or electrical breakdown. The exclusion relating to mechanical beginning 24 hours after the and break -down does not apply to the ending, regardless of the policy accidental discharge of an air bag. expiration, with the number of days reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto'. If the "loss' Is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered "auto" and return it to you or the If a covered 'auto" is awned or leased and number of days it takes for the claim to be settled, whichever comes first. if we provide Physical Damage Coverage on it, we will pay, in the event of a covered b. Our payment is limited to necessary and total "loss", any unpaid amount due on the actual expenses incurred. lease or loan for a covered "auto", less: c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos' Damage Coverage Section of the available to you for your operations. policy; and d. If a "loss" results from the total theft of a b. Any: covered "auto" of the private passenger (1) Overdue lease or loan type, we will pay under this coverage payments including penalties, only that amount of your rental reimbursement expenses which is not interest or other charges already provided for under the Physical resulting from overdue Damage Coverage Extension. payments at the time of the loss"; J. "Personal Effects' Exclusion (2) Financial penalties imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss" to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value, by the lessor; and b. Bullion, gold, silver, platinum, or other (6) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0716 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 6 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE Is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss'. If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the first"loss" 1 0% 2 25% 3 50% 4 75% 5 1 100% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit' or "loss" to us or our authorized representative only applies after the "accident', claim, "suit' or "loss" is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (6) Your insurance manager; or (6) Your legal representative. P. aiver Of Subrogation For Auto Liability osses Assumed Under Insured Contract Item 6. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have (Q).under this Coverage Form. Ioncontributory surance Is Primary and Subpart a. of Item 6. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 6..Other Insurance of Paragraph B. General Conditions under SECTION IV— BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos' you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract In that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains In effect. CA990107 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER•ATN2376531 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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' or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional Insured and included in the "products -completed operations hazard". 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER'ATN2376531 COMMERCIAL GENERAL LIABILITY CG 2012 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART I.901 s111111111 3I State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work A. Section II — Who Is An Insured is amended 2. This insurance does not apply to: to include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political subdivision shown in the Schedule, °personal and advertising m�ury" arising for the subject to the following provisions: out of operations performed federal government, state or 1. This insurance applies only with respect to municipality; or operations performed by you or on your b. "Bodily injury" or "property damage" behalf for which the state or governmental included within the "products - agency or subdivision or political completed operations hazard". subdivision has issued a permit or authorization. B. With respect to the insurance afforded to these additional insureds, the following is added to However: Section HI — Limits Of Insurance: a. The insurance afforded to such additional insured only applies to the If coverage provided to the additional insured is by the required a contract or agreement, extent permitted by law; and most we will pay on behalf of the additional b. If coverage provided to the additional insured is the amount of insurance: insured .a required by a contract or 1. Required by the contract or agreement; or agreement, the insurance afforded to such additional insured will not be 2• Available under the applicable Limits of broader than that which you are Insurance shown in the Declarations; required by the contract or agreement to whichever is less. provide for such additional insured. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 0413 © Insurance Services Office, Inc., 2012 Page 1 of t WORXrRS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: 10/01/2022 Policy No.76000055S7221 Endorsement No.00I Insured: Tri-Star Contracting H, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WC1RB's California Workers' Compensation Insurance Forms Manual -1999. Policy #ATN2376531 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART,and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specificproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Required By Written Contract, Fully Executed Prior To The Named Insured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 POLICY NUMBER ATN2376531 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) s Or Or anizatioFL' Locations Of Covered Operations s equlre y rltten t ontract, Fully As equlre y Written Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work 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 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 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: 2• 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. 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 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. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Of the the Page 2 of 2 0 Insurance Services Office, Inc., 2012 GG 20 10 04 13 POLICY NUMBER ATN2376531 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included In the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 O fr TRISCON-02 CMAYO 1 '`�`� CERTIFICATE OF LIABILITY INSURANCE op61TE 26/2ozn3 ) 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(les) 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 Ileu of such endorsements . PRODUCER License 1110767776 CONTACT Diane Nielsen �ptcNNo, Ex , (760) 36Od700 4742 Fiu'ixc Na :(760) 200-9706 HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite201 Mkss.diane.nielsen hubintemational.com Palm Desert, CA 92211 INSUREFUSI AFFORDING COVERAGE NAIC p INSURER A:UDltEdSpecialty Insurance Company 12537 INSURED INSURERB:Wesco Insurance Company 25011 INSURER C: Everest Premier Insurance Company 16045 Tri-Star Contracting II, Inc. 6Iar, Inc. 15-501 Little Morongo Road INsuRERD: TravelersProperty Casualty Company of America 25674 Desert Hot Springs, CA 92240 INSURER E: INSURERF: rnvvowr_ee CERTIFICATE MUMRFR: RFVIRION NtIMRER- 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 SUER POLICY NUMBER POLICY EFF POLICY UP OMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑X OCCUR X I( ATN2376631 6126/2023 6/2612024 DAMAGE TO RENTED PREMISES (Ea �I 50,000 X MED EXP An Foe mon 5,000 $6,000 Deductible PERSONAL S ADV INJURY S 1,000,000 GEN'L AGGREGATE LIgMpIIT. APPLIES PER: POLICY jEC7 LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGO S 2,000,000 f OTHER B AUTOMOBILE LIABILITY COMaINEOSINGLE LIMIT 1,000,000 BODILY INJURY Per nc,i f ANY AUTO X X PP1987680-00 11/2312022 11/23/2023 BODILY INJURY Par accWenl AUgT�O�S ONLY AuprrNN06wWLED Ix AUTOS ONLY X AUTOONLV PPerOacEClRdant AMADE $ f A X UMBRELLA OAB X OCCUR EACH OCCURRENCE f 2,000,000 EXCESS MS CWMS-MAOE BTN2370408 W2W2023 612612024 AGGREGATE f 2,000,000 DELI I I RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICEOPPIRIIETOERREXCLUDE09ECUTNE Y❑ (Mandatory In NH) NIA X 7600005937221 10/1/2022 1011/2023 X I PER OTH- E.L. EACH ACCIDENT 1,000,000 EL. DISEASE - EA EMPLOYE 1'000'OOO E.L. DISEASE - POLICY UMIT S 1,000,000 If yyes, descdt* urMer DESCRIPTION OF OPERATIONS be. D Equipment Floater 6606072C693 1/11/2023 111112024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiliorul Remarks Schedule, may M iBacMd If more space Is required) Job -Annual Traffic Calming Projects, FY 22.23 The City of Palm Springs, its officials, employees and agents are named as additional insured per attached CG2010 0413 and CG2037 0413 (GL) and Automobile. Insurance is primary/noncontributory. Waiver of Subrogation applies to Workers Compensation, General Liability and Auto. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium reoTICIr ATO Mnl noe CAMCFI I ATInM RECEIVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Palm Springs J U N 2 9 2023 THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY P OVISIONSCE WILL BE DELIVERED IN 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 Hall Clay Reception Desk AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER- WPP1987680-00 COMMERCIAL AUTO CA990187 0716 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply by the endorsement. 0modified y Acquired or Formed e. An "employee" of yours is an "insured" Organizations, Employee Hired Car while operating an "auto" hired or rented Liability and Blanket Additional Insured under a contract or agreement in that Status for Certain Entitles. "employee's" name, with your Item 1. Who Is an Insured of Paragraph A. permission, while performing duties to the conduct of business. C d SECTION II COVERED related your overage un er — AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 1 B& day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE Is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION 11— COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 6 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage —Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is Indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto . F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses Incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured' while in a covered 'auto" subject to a maximum limit of $2,500 per "loss', for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting 'downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5" day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for'downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto* available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, Is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto' because of "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto'. If the "loss' is caused by theft, this number of days is the number of days it takes to locate the covered "auto" and return it to you or the number of days it takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. d. If a "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects' Exclusion Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Exclusion We will not pay for "loss' to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. d. Contraband or property in the course of illegal transportation or trade. e. "Loss" caused by theft, unless there is evidence of forced entry into the covered "auto" and a police report is filed. K. Accidental Alrbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto' is owned or leased and if we provide Physical Damage Coverage on it, we will pay, in the event of a covered total "loss', any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease or loan payments including penalties, interest or other charges resulting from overdue payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) Security deposits not refunded by the lessor; and (5) Carry-over balances from previous loans or leases CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss ", only one deductible will apply to that "loss". if the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first 'loss' reported during the corresponding policy period: Loss Free Policy Periods With the Expansion Endorsement Deductible Reduction on the first"loss" 1 0% 2 25% 3 50% 4 75% 5 100% If we pay a Physical Damage"loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, "suit" or "loss" is known to: (1) You, if you are an individual, (2) A partner, if YOU are a partnership, (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, If you are a limited liability company; (6) Your insurance manager; or (6) Your legal representative. P. alver Of Subrogation For Auto Llabllity osses Assumed Under Insured Contract Item 6. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 6. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. surance is Primary and oncontributory Subpart a. of Item 6. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 5..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract In that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not Intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered 'auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission POLICY NUMBER ATN2376531 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 WORI(ERS COMPENSATION AND EMPLOYERS LL 21LITY INSURANCE POLICY WC 04 03 06 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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:10/01 /2022 Policy No. 7600005937221 Endorsement No. 001 Insured: Tri-Star Contracting II, Inc. Premium S INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual- 1999. POLICY NUMBERATN2376531 COMMERCIAL GENERAL LIABILITY CG 2012 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required By Written Contract, Fully Executed Prior To The Named Insured's Work 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the products - completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section HI —Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreements 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy #ATN2376531 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 051 00 (02120) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE PART,and supersedes any provision to the contrary: Primary and Non -Contributory Insurance Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: a. (1) The Additional Insured is a Named Insured under such other insurance; and (2) A fully written contract fully executed prior to the Named Insured's commencement of work for such Additional Insured for the specificproject that is the subject of the claim, "suit," or "occurrence" expressly requires that this insurance: (i) apply on a primary and non-contributory basis; and (ii) would not seek contribution from any other insurance available to the additional insured. or b. Prior to a loss, you request in writing and we agree in writing that this insurance shall apply on a primary and non-contributory basis. Requlred By Written Contract, Fully Executed Prior To The Named Insured's All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (02/20) Page 1 of 1 POLICY NUMBER ATN2376531 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 14M.101111A2 Name Of Additional Insured Person(s) Or Or anization Locations Of Covered Operations s Require y rltten Cosntract, Fully As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work 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, 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. CG 2010 0413 0 Insurance Services Office, Inc., 2012 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Of the the Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBERATN2376531 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Organization: an Contract, Fully Executed Prlor To The Named Insured's Work 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or .your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 0 TRISCON-02 DNIELSEN n DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE A`"I' 11122/2023 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). License # 0757776 CONTACT Diane Nielsen PRODUCER NAME: _ HUB International Insurance Services Inc.HONE 75030 Gerald Ford Drive (AIIC, No, Ext): (760) 360-4700 4742 FAX No>:(760) 200-9706 Suite201 E p'L .diane.nielsen hubinternational.com Palm Desert, CA 92211 INSUREIRIS) AFFORDING COVERAGE NAIC # itignRFR e • United SoecialtV Insurance Comoanv 112537 INSURED Tri-Star Contracting II, Inc. Telar, Inc. 15-501 Little Morongo Road Desert Hot Springs, CA 92240 B : Security National Insurance c:Everest Premier Insuranc D:Travelers Property Casualty E: F: of America --,—A— kl=o. DC\/IQ1l%A1 A11111aDCD- 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 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X ATN2376531 6/26/2023 6/26/2024 AMAGESIETO DPR $ 50,000 $5,000 Ded BI & PD X MED EXP (Any oneperson) $ 5'000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EK 7ref LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT c 'de t 1,000,000 $ BODILY INJURY Perperson) $ X ANY AUTO SPP181817800 11/23/2023 11/23/2024 BOODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PPerOacEcandent AMAGE $ X AUTOS ONLY X AUTOS ONL� X No Deductible $ A UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS -MADE BTN2370408 6/26/2023 6/26/2024 X AGGREGATE $ 2,000,000 X DIED RETENTION$ 0 Following Form C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFI CER/MEMBER EXCLUDED? (Mandatory In NH) N/A 7600005937231 1011 /2023 10/1/2024 X PERT OTRH- E.L. EACH ACCIDENT 1,000,000 $ 1,000,000 $ E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below D Equipment Floater 6606072C693 1/11/2023 1/11/2024 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Wood Res., 777 Panorama Rd., Palm Springs, CA City of Palm Springs its officials, employees and agents are named as additional insured per attached CG2010 0413. 30 days written notice will be given to the certificate holder should any of the above policies be cancelled before the expiration date. 10 days notice applies for non payment of premium RECEIVED City of Palm Springs 3200 E Tahquitz Canyon Way NOV 7 2023 Palm Springs, CA 92262 City Hall Reception Desk 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 4 "4-- ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION The ACORD name and logo are registered marks of ACORD AgU7 A(514y� All rights reserved. to u,lir� e POLICY NUMBER ATN237653,1 COMMERCIAL GENERAL LIABILITY' CG20100413 ,. THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD -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 Or anization s Locations .Of Covered Operations As Required by Written Contract, Fully As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above will be shown in the Declarations. `A. Section 11 -- 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 locations) 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. 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. CG 2010 0413 ©.Insurance Services Office, Inc., 2012 Page 1. of 2 C. With respect to the insurance afforded to these .2. Available under . the applicable Limits of additional. insureds, the following is added to Insurance shown in the Declarations, Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the., required by a contract or agreement, the most we applicable_ Limits .of Insurance shown in the will pay on behalf of the additional insured is the Declarations.. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 insurance Services Office, Inc., 2012 CG 20 10 0413