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HomeMy WebLinkAboutA9448 - FAIR HOUSING COUNCIL OF RIVERSIDE COUNTY, INC (Block Grant FY 23-24)______, ACORD@ ~ CERTIFICATE OF LI ABILI TY INSURANC E DATE (MM/DD/YYYY) 7/8/2025 THIS CERTIFIC ATE IS IS SUE D A S A MATTER OF INFORMATIO N O N LY AND CON FERS N O RIG HTS U PON T H E CERTIFICAT E H O LDER. T HIS C ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAT IVELY AMEND, E X TEN D O R ALTER THE C OVE RAG E AFF ORDED BY THE POLICIES BEL OW. THIS C ERTI FICATE OF I N S URANCE DOES NOT CONSTITUTE A CO NTRACT B ETWE EN THE I SSUI N G INSURER(S), A UTHO RIZED REP R ESENTATIVE O R PRODUC ER, AND THE C ERTIFI CATE HOLDER. IMPORTANT: If the c erti f icate holde r i s a n ADDIT IONAL INSU RED, t h e p o lic y(ie s) must be e ndors ed. If S UBROGATION IS W A IV ED, subject t o the terms and conditions o f the p o l i c y , certain polici R mGli.¥60end orseme nt. A s tate m e nt o n this certificat e d oes not confer rights t o t h e c ertific at e holde r in lie u of such e ndo rse m ent (s). PRODUCER Empire Company 9050 Archibald Avenue Rancho Cucamonga INSURED JUL 14 2025 OFFICE OF THE CITY C CA 91730 Fair Housing Council of Riverside County, Inc. P.O. Box 1068 Cathy Negron 0 Ext. (909) 476-0600 INSURE R A: Non INSURER C : INSURER D : INSURER E: Riverside CA 92502-1068 INSURERF: COVERAGES CERTIF ICATE NUMBER: 25/26 UPTD MASTER FAX A/C No : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF I NSURANCE LISTED BELOW HAVE BEEN ISSUED TO T HE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A LL THE TERMS, EXCLUSIO NS AND CONDIT IONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR ,;~Mg~ POLI CY EXP LTR TYPE OF INSURANCE 1,.,m l u nm POLICY NUMBER I MM/DD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ,__ n CLAIMS-MADE LJLl OCCUR DAMAGE 1~ RENTED A PREMISES Ea occurrence\ s ~ SOCIAL SERVICE PROFESSIONAL X Ol-CP-0004221-01 -26 4/28/2 0 25 4/28/2026 MED EXP (Arry one person) $ $2MILLION ANN AGGREGATE PERSONAL & ADV INJURY s ,_ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s ~ POLICY □ jrg: □Loe PRODUC TS -COMP/OPAGG s OTHER: s AUTOMOBILE LIABILITY ~~~~~1r 1NGLE LIMIT s ~ ANY AUTO BODILY INJURY (Per person) s A ,__ ALL OWNED -SCHEDULED AUTOS AUTOS Ol-CP-000 4221-01-2 6 4/28/2025 4/28/2026 BODILY INJURY (Per accidenl) s .__ -X X NON-OWNED rp~~RJ,;,~MAGE $ HIRED AUTOS AUTOS ~ 1--$ X UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ ~ A EXCESS LIAB CLAIMS-MADE AGGREGAT E $ OED I I RETENTION $ Ol-UB-0004221-01-03 4/28/2025 4/28/2026 $ WORKERS COMPENSATION I PER 1 l OTH- A ND EMPLOYERS' LIABI LITY X STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? B (Mandatory In NH) y PEG28Jg45711 7/1/2025 7/1/2026 E.L. DISEASE -EA EMPLOYEE $ If yes, desonbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 5 A DIRECTORS & OFFICERS LIABILITY Ol-CP-0004221-01 -26 4/28/2025 4/28/2026 ANN AGG/EAC H OCC A EMPLOYEE DISHONESTY LIMIT DESCRIPTION OF OPERATIO NS I LOCATIONS I VEHICLES (ACORD 101, Addi tiona l Remarks Schedule, may be attached If more space Is req uired) The Cit y of Pal m Springs, its officers, employees & agents are named as Additiona l Insured with r espect to the General Liability per form (CG 20 10 12 19) & (CG 20 37 12 19) attach ed as required by written con tract . Waiver of Subrogation applies to Workers Compensation per form attached (WC 99 07 00 A) . *30 day notice of cancellation applies except 1 0 day notice for non-payment of premium. CERTIFICATE H OLDER CANCELLATION NAIC # NONIN2 10900 1 ,000,000 500,000 20,00D 1 ,000,000 2 ,000,000 2,000,000 1,000,000 1 000 000 1,000,000 1 000 000 1 ,000 000 1 000 000 $2M/$1M $200 ,000 Cit y of Pa lm Sprin gs Attn: City Clerk/Dale Cook P .O . Box 2 7 43 SHOULD A NY OF TH E ABOVE DESC RIBED PO LI CIES BE CANCEL LED BEFORE TH E EXPIRATION DATE THEREOF, NOTICE WI LL BE DELIVERED IN ACCORDAN CE WITH TH E POLICY PROVISIONS. Pal m Springs, CA 92262 ACORD 25 (2014/0 1) IN S025 (201401) AUTHORIZED REPRESENTATIVE Cathy Negro n/EMPCNl © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and l ogo are regi stered marks of ACORD -~ I DATE (MMlt>DIYYYY) --5/5/2025 THIS CERTIFICATE I S ISSUED AS A MATTER OF INFORMATION ONLY AND CON FERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE A FFORDED BY THE POLICI ES BELOW. THIS CERTIFI CATE 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 INSURE~ policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to tho ter ms and conditions of the policy, certain politAOOE•¥ endorsement. A statement on this certificate does not confer r ights to the certificate holder in lieu of such endorsement(s). PRODUCER MAY 1 2 2025 '-V<"""" Cathy Negron NAME· Empire Company r4H,)?N_\=n .,.,,. (90 9) 4 76-0600 1rffc Nol: 9050 Archibald Avenue OFFICE OF THE CITY CL ~ss: cnegron@empire-co.com -.. , INSURER(S) AFFORDING COVERAGE NAIC I Rancho Cucamonga CA 91730 INSURER A : N onprofits Insurance Alliance Group NONIN2 INSURED INSURER B: Preferred Emplovers Insurance Company 10900 Fair Housing Council o f Riverside County, Inc. INSURERC: P.O. Box 1068 INSURE R D: INSURER E : Riverside CA 92502-1068 INSURER F: COVERAGES -CERTIFICATE N U M BER:25-26 MASTER REVISION N U M BER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE IN SURED NAM ED A80VE FOR THE POLICY PERIOD INDICATED NOlv\llTHSTANDING ANY REQUIREM ENT, TERM OR CONDITIO N OF ANY CONTRACT OR OTHER DOCUME NT WITH RESPECT TO WrllCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , TH E IN SU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREI N IS SUBJ ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PA ID CLAIMS . INSR TYPE OF INSURANCE ADDL SUBR POLICYEFF POLICY EXP LIMITS LTR •••~n ···~ POLICY NUMBER fMM/00/YYYYI f MINDDIYYYYl X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 A -_J CLAIMS-MADE W OCCUR Ul\l'MuC. TO RENTED PREMISES IEe ,,,..., ... nee, s 500,000 X -SOCIAL SERVICE PROFESSIONAL X 01-CP-0004221-01-26 4 /28/2025 4 /28/2026 MEO EXP (Any one person) $ 20,000 -$2MILLION ANN AGGREGATE PERSONAL & ADV INJURY $ 1 ,000,000 GENl. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 ~ POLICY D ff& D LOC PRODUCTS· COMP/OP AGG $ 2 ,000,000 OTHER: $ AUTOMOBILE LIABILITY -TE~!~~!.~l1NGLE LIMIT s 1,000,000 ANYALITO BODILY INJURY (P..-person) s A -ALL 0'1'-tNEO -SCHEDULED AUTOS AUTOS Ol-CP-0004 221-01-26 4 /28/2025 4/28/2026 BODILY INJURY (Per accident) s --fllON..O'MIEO PROPERTY DAMAGE X HIRED AUTOS X AUTOS rPN acadeoll s --s X UMBRELLA LIAB HOCCUR EACH OCCURRENCE s 1 000 000 - A EXCESS LIAB CLAlM $-MADE AGGREGATE $ 1,000 000 OED \ I RETENTION s Ol-UB-0004221-01-03 4 /28/2025 4 /28/2026 s WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY X ~TATllT~ ER Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? NIA B f1Mnd1tory In NHJ y PJ:G28394 57ll 7/1/2024 7/1/2025 E .L DISEASE · EA E MPLOYEE s 1 000 000 grn:R'l1>¥i~~ ori~ERATIONS below E L. DI SEASE • POLICY LIMIT $ l 000 000 A DIRECTORS & OFFICERS LIABILITY Ol-CP-0004 221-01-26 4 /28/2025 4/28/2026 ANH AG-0/EA OCCURRENCE $2H/$1M A EMPLOYEE DISHONESTY U MIT $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiUonal Remarks Schedule, may be attached II more space is required) The City of Palm Springs, its officers, employees & agents are named as Additional Insured with respect to the General Liability per form(CG 20 10 12 19) & (CG 20 37 12 19) attached as required by written contract. Wa iver of Subrogation applies to Work ers Compensation per form attached (WC 99 07 00 A). *30 day notice of cancellation applies except 10 day notice for non-payme nt of premium. CERTIFICATE H OLDER CAN CELLATION City of Palm Springs Attn: City Clerk/Dale Cook P.O. Box 2743 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL B E DELIVERED IN ACCORDANCE W ITH THE POLICY PROVISIONS. Palm Springs, CA 92262 ACORD 25 (201 4/01) INS025 1201,01) AUTHORIZED REPRESENTATIVE lcathy Negron/EMPCNl ~1!£g1()y'] © 1988-2014 ACORD CORPORATION. A ll rig hts reserved . T he ACORD name a n d logo a r e r egistered marks of ACORD I I I I