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HomeMy WebLinkAbout23C133 Shade Structures , Inc (2)A oRd CERTIFICATE OF LIABILITY INSURANCE DATE(MMDO/YYW) 10/02Y2026 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 Ann Risk Services Central, Inc.PHONE St. Louis MO Office SuiteDuncan Avenue RECEIVED CONTACT (AC. No. EXD: (966) 283-7122 ODD) 363-0105 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC m St Louis No 63110 USA INSURED oueT INSURER A: lames River Insurance Company 12203 shade Structures, Inc. USA SHADE & FABRIC STRUCTURES C/o vPS 2590 Esters Blvd., suite 100 OFF OF THE CITY C INSURERS: Pennsylvania Manufacturers' ASSOC Ins CO 12262 c: Manufacturers Alliance Ins Cc 36897 DFw Airport, TX 75261 USA INSURER D: Columbia Casualty Company 31127 INSURER E: Allied world Assurance company (US) Inc 19489 INSURER F: COVERAGES CERTIFICATE NUMBER: 570108744069 REVISION NUMBER: THIS G 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. Limits shown are as requested INBR Tq TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDOIYYY MMIDONY LIMITS X COMMERCIALGENERALLIABILRY EACHOCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR PREMISES Ea accurrerX:e $300,000 X MED EXP (Any one person) $To. 000 XCU rwt ex l PERSONAL& ADV INJURY $1,000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 PRO - POLICY EJECT � LOC JECT PRODUCTS - COMPIOPAGG $2,000.000 OTHER: B AUTOMOBILE UASILRY 152400 0652321A 10/01/20241010112025 OOMBMED SINGLE LIMIT $1,000,000 Auto ADS ROOKY INJURY (Per Person) C X ANYAUTO Y y 152400 0652321E 10/01/2024 10/01/2025 OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY Auto CA BODILY INJURY (Per emblem) PROPERTY DAMAGE Pn epeitlent E X UMSFIELLAUAB X OCCUR 1 O EACH OCCURRENCE $5.000,000 EXCESS LIM CLAIMS -MADE AGGREGATE $5,000,000 OEO I X RETENTION 310,000 B WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY YIN ANVPROPRIETORI PARTNER I EXECUTIVE OFFICERVEMSER EXCLUDED' N (Mandatory In NM NIA Y 4 X PER STATUTE IFSTH- E.L. EACHACCIDENT $1,000,000 E.L DISEASE -EA EMPLOYEE $1,000,000 M yx tlesc Ur , DESCRIPTION OF OPERATIONS meow E.L DISEASE-01_ VLIMB S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AENmonsl Remwks ScWuM, my be amAekea N more spore M rommeM The per location agggregate is subject to a policy cap of $10,0001000. RE: Palm Springs City Project 20-28. The General Liability (ongoing & Completed Operations) and Automobile Liability Policies include a blanket Additional insured endorsement in favor of City of Palm Springs, its officials, employees and agents that provides this feature only when there is a written contract with the Named Insured that requires such status. General Liability policy is Primary and Non -Contributory. The General Liability, Automobile Liability and workers' Compensation policies include a blanket waiver of Subrogation endorsement in favor of City of Palm Springs, its elected officials, employees and agents that provides this feature only when there is a written contract with the Named Insured that requires such status. Umbrella policy is follow form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ..3�pLr POLICY PROVISIONS. City of Palm Springs AUTHORIZED REPRESENTATIVE Attn: City Manager & City Clerk Palm E. Tanquitz Can on Way Palm Springs CA 92262 USA c.iONo/» c;9988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD a m c m O m a x° e: 0 N AGENCY CUSTOMERIO: 570000052633 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY - Aon Risk services central, Inc. NAMEDINSURED shade structures, Inc. . ' POLICYNUMBER See certificate Number: 570108744069 CARRIER - _ see Certificate Number: 570108744069 NAIC CODE EFFECTIVE DATE: - THIS ADDITIONAL REMARKS FORM IS -A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance . INSURER(S) AFFORDING COVERAGE I NAIC # I II ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD' certificate form for policy limits. LNSR LTA TYPE OF INSURANCE ' ADDL INSD SUER tt'VD POLICYNUa1BER POLICY EFFECTIVE DATE (hII,VDD/YYYY) POLICY . EXPIRATION DATE (AINUDDA'WY). LIa11TS EXCESS LIABILITY D 7040440664 01 Excess $SM x $SM 10/01/2024 10/01/2025 Aggregate $5,000,000 Each Occurrence $5,000.000 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: W0000052633 LOC #: `'✓ ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY - ADD Risk services Central, Inc. NAMEDINSURED shade structures, Inc. _ - POLICYNUMBER See Certificate'Number: 570108744069 - CARRIER- see certificate Number: 570108744069 NAIC CODE EFFECTIVE DATE: Nq ADDITIONALREMARKS THIS.ADDITIONAL,REMARKSFORMISASCHEDULETOACORD FORM, FORM NUMBER:. ACORD 26- FORM TITLE: Certificate of Liability.lnsurance Companies Affording coverage LINE OF BUSINESS DESCRIPTION POLICYNUMBER POLICY EFFECTIVE DATE (AIAUDD)YYYY) POLICY EXPIRATION DATE (MMMONYYY) COMPANY NAIC PRIMAR (YR9 FLAG PERCENTAG OF RISK General Liability coverage - 000959655 10/1/2024 10/1/2025 James River Insurance Company - 12203 y 100 Umbrella Liability 03140086 10/1/2024710/1/2025 Alliecf World Assurance Company (US). Inc 19489 Y 100 " Business Auto Coverage - - 152400 0652321A 10/1/2024 10/1/2025 Pennsylvania Manufacturers' Assoc Ins Co 12262 Y 100 Business AutoCoverage 152400 0652321E 10/1/2024 10/1/2025 manufacturers Alliance Ins Co. 36897 Y 100:- Workers. compensation ' 2024750652321 ' 10/1/2024 10/1/2025 Pennsylvania manufacturers' Assoc Ins Co 12262 Y 100 Excess Liability Coverage 7040440664 10/1/2024 10/1/2025. Columbia Casualty Company 31127 .Y - 100 The Subscribing insurers, obligations under contracts of insurance to which they subscribe are several .and not joint and are limited solely to the extent of their individual subscriptions. The subscribing insurers are not responsible for the subscription of any co -subscribing insurer who for any reason does not'satisfy all or part of its obligations. . ACORD 101 (2008/01) - - 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 POLICY NUMBER: 00095965-5 COMMERCIAL GENERAL, LIABILITY CG.2026 04 13 THIS ENDORSEMENTCHANGESTHE POLICY. PLEASE READIT CAREFULLY. ADDITIONAL INSURED -DESIGNATE D PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Of Additional Insured Person(6)Or Organization(s): Where required by written contractor written agreement., A. Section II Wlio 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", "property damage" or 'personal; and advertising injury" .caused, in whole or in part, by your acts` or - omissions or the acts or omissions of those acting. on your behalf: A. In the performance of your ongoing operations; or 2. In connection with,your premises owned by or - rented to you. However: -1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.' If coverage providedao'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. shown in the Declarations. 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 contractor 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 26 0413 ©Insurance Services Office, Inc., 2012 Page 7 of 1 POLICY NUMBER: 00095965-5 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 Organization(s) Locations Of Covered Operations Where required by written contract or written agreement All operations of the Named Insured Information re wired 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. a 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 contractor 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 1 CG 20 10 0413 POLICY NUMBER: 00095965-5 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 Where required by written contract or written agreement All operations of the Named Insured 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 organizations) 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; whicheveris less. This endorsement shall .not increase the applicable Limits of Insurance shown in the Declarations. W CG20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of POLICY NUMBER: 00095965-5 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE, POLICY. PLEASE READ IT CAREFULLY. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: 00096965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT " ' This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Or anization s : If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. ' I - ` 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 written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. 15 AP5031 US O4-10 Page 1 of 1 POLICY NUMBER: 00095965-5 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/COMPLETEDOPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where required by written contract or written agreement 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 ❑ POLICY NUMBER: 00095965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE LIMITS OF INSURANCE PER LOCATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION III — LIMITS OF INSURANCE - The General Aggregate Limit applies separately to each "Location" of the Named Insured. Notwithstanding the application of the General Aggregate Limit to each "Location" of the Named Insured, under no circumstances will we pay more than $10,000,000 for all claims under this policy that are subject to the General Aggregate limit. For the purpose of this endorsement, the following definition is added: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5011 US 12-03 Page 1 of 1 POLICY NUMBER: 00095965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE .LIMITS OF INSURANCE PER PROJECT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS COMBINED LIABILITY POLICY SECTION III — LIMITS OF INSURANCE - The General Aggregate Limit applies separately to each "Project" of the Named Insured. Notwithstanding the application of the General Aggregate; Limit to each "Project"'of the Named Insured, under no circumstances will we pay more than $10,000,000 for all claims under this policy that are subject to the General Aggregate limit; For the purpose of this endorsement, the following definition is added: "Project" means all work done by you or on your behalf, away from premises owned or rented to you, to complete an individual bid or negotiated contract to provide services for a specified period of time. Multiple jobs, work orders, purchase orders; or work done at multiple "locations" under one contract are not separate "projects" within the meaning of this coverage. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP6012US 12-03 Page 1 of 1 POLICY NUMBER: 162400 0652321A COMMERCIAL AUTO, CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this -endorsement, the provisions of the Coverage ,Form apply unless . modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business. Auto Coverage Form and the Other Insurance— Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage .Form's, Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". CA 04 49 11 16 ©'Insurance Services Office, Inc., 2016 INSURED COPY Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CAM 481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED INSURED FOR COVERED, AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage .provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered -Autos Liability Coverage under the Who Is An Insured provision of f the Coverage Form. This endorsement does not alter coverage provided in, the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: 10/1/2024 SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule if not shown above will be shown in the Declarations. Each person or organization shown in the Schedule is an ".insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 1 — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 152400 0652321A COMMERCIAL AUTO PCA 05 04 04 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF RECOVERY RIGHTS This endorsement modifies coverage provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM We waive any right of recovery that we may have against the person or. organization shown in the SCHEDULE because of payments .we make for injury or damage arising out of the operation of an insured "auto'; but such waiver is only effective if the Named Insured has entered into a written contractor Name of Person or Organization: agreement with that person or organization, if such contract or agreement is made and dated prior to the injury or loss, and if such written contract or agreement requires a waiver'ofrecovery rights. This waiver applies only to the person or organization shown in the SCHEDULE below. SCHEDULE. AS REQUIRED BY WRITTEN CONTRACT. PCA 05 04 04 14 Includes copyrighted material of Insurance. Services Office, Inc. with its permission The PMA Insurance Group, 2014 INSURED COPY Page 1 of 1' POLICY NUMBER: 202475 0652321 WORKERS COMPENSATION AND EMPLOYERS LIABILrry INSURANCE POLICY WC 00 0313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right.to recover our payments, from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE AS REQUIRED BY WRITTEN CONTRACT EXECUTED PRIOR TO, THE DATE' OF LOSS. 190 National Council on Compensation Insurance. INSURED COPY' Certificate No: 570108744073 AON City of Palm Springs Attn: City Manager & City Clerk 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 USA Friday, October 4, 2024 To whom it may concern: Following a concentrated effort to reduce our environmental footprint and provide timely certificate delivery, Aon will begin delivering our Certificates of Insurance electronically in PDF format. Please utilize one of the following methods to ensure you will receive the electronic copy of your Certificate (Certificate No: 570108744073) for future renewals: - Visit aon.com/e-cert; or - Utilize the QR Code below to enter/validate your information. If your email address has changed or will be changing in the future, or you no longer require this certificate, please let us know using one of the methods above. Thank you for your cooperation and willingness to help us reduce our impact to the environment. Aon Risk Services 5801 Postal Road PO Box 818037 Cleveland, Ohio 44181-9600 0 ® CERTIFICATE OF LIABILITY INSURANCE DATE o� ODZaYYY) 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..lf - 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 endorsemenl(s). PRODUCER ADD Risk services central, Inc. St. Louis MO Office CONTACT PAN FAX (Ac. No. EXt): (866) 283-7122 AC. No.: (800) 363-0105 E-MAIL ADDRESS: 4220 Duncan Avenue Suite 401 INSURER(S)AFFORDING COVERAGE NAICp St .Louis MO 63110 USA INSURED INSURER A: IameS River Insurance company 12203 shade structures, Inc. USA SHADE $.FABRIC STRUCTURES C/O VPS 2580 Esters Blvd., suite 100 INSURER B: Pennsylvania Manufacturers' ASSOC Ins Co 12262 INSURER C: Manufacturers Alliance Ins c0 36897 DFw Airport, TX 75261 USA INSURER o: Columbia casualty Company 31127 INSURER E: Allied world Assurance company (Us) Inc 19489 INSURER F: COVERAGES .CERTIFICATE NUMBER: 570108744073 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. Limits shown are as requested LTA TYPE OF INSURANCE INSD WVO POLICY NUMBER MMIODNYVV) (MODON"Yl OMITS MMERCIAL GENERAL LIABILITY EACHOCCURRENCE $1,000,000 CLAIMS -MADE �X OCCUR Tx__Xc PREMISESBe occurrence- $300, 000 MED EXP (Any one person) $10, 000 U not excl PERSONAL B ADV INJURY $1,000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY �X PEO �X LOC PRODUCTS-COMRIOPAGG $2,000,000 OTHER: B AviOMOBILE LIABILITY 152400 0652321A Auto ADS 10/01/202410/01/2025 COMBINED SINGLE LIMIT Ea amide t $1,000,000 BODILY INJURY (Per person) C % ANYAUTO Y Y 152400 0652321E 10/01/2024 10/01/2025 BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS I I EDAUTOS NON -OWNED ONLY AUTOS ONLY Auto CA PROPERTYDAMAGE Per accident E X UMBRELLALIAB % OCCUR 03140086 10 01 2024 10 Ol 2025 EACH OCCURRENCE $5,000,000 EXCESS LIAR I CLAIMS -MADE AGGREGATE $5,000,000 DED X RETENTIONS10,000 B WORKERS COMPENSATION AND EMPLOYERTUABILITY YIN ANY PROPRI ETOR I PARTNER I EXECUTIVE OFFICENMEMBER EXCLUDED? (Mandatory in NH) NIA Y 20 47506 22321 10 Ol 02410 Ol 2025 X I PER STATUTE OTH- I IER E.LEACHACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DE SCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddiOonal Remarks Schedule, may he attached If more space is required) The per location agggregate is subject to a policy cap of $10,000,000. RE: Palm springs city 20-28. The General .Project Liability (ongoing & completed operations) and, Automobile Liability Policies include a blanket Additional Insured endorsement in favor of city of Palm springs; its officials, employees and agentsthatprovides this feature only when there is a written contract with the Named -Insured that. requires such status. General Liability policy is Primary and Non -Contributory. The General Liability, Automobile Liability .and workers' Compensation policies include a blanket waiver of Subrogation endorsement in favor of city of Palm springgs, its elected officials, employees and agents that .provides this feature only when there is a written contract with the,Nametl insured that requiressuchstatus. Umbrella policy is follow form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL Be DELIVERED IN ACCORDANCE WITH THE �4 POLICY PROVISIONS. ^l' City of Palm springs AUTHORUMD REPRESENTATIVE Attn: city Manager & City clerk 3200 E. TahquiA canyon way J i lei l —��L Palm Springs CA 92262 USA c!�'\/o%L %LnCQ//l CC�!/6 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD a L AGENCY CUSTOMER ID: 570000052633 LOC #: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED shade Structures, Inc. POLICYNUMBER See Certificate Number: 570108744073 CARRIER See Certificate Number: 570108744073 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER TYPE OF INSURANCE INXD {WD EFFECTIVE DATE (AIAUIID/YYYY) EXPIRATION DATE (nl\VDD/YYY1) EXCESS LIABILITY p 7040440664 01 Excess $SM x $SM 10/01/2024 10/01/2025 Aggregate $5,000; 000 - Each occurrence $5;000, 000 e ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000052633 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY - ADD Risk service's Central, Inc. NAMEDINSURED shade structures, Inc. POLICYNUMBER see certificate Number: 570108744073 CARRIER see Certificate Number: 570108744073 NAIL CODE EFFECTNE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, Companies Affording coverage LINE OFBUSLNESS DESCRIPTION POLICY NUMBER POLICY EFFECTIVE DATE (ATM/DD/YYYY) POLICY EXPIRATION DATE (MM)DD)YYYY) COMPANY NAIC PRLUARI FEN FLAG PERCENTAGE OF RISK General Liability Coverage 000959655 10/1/2024 10/1/2025 James River insurance Company 12203 Y 100 umbrella Liability 03140086 10/1/2024 10/1/2025 Allied world Assurance Company (US) Inc 19489 Y 100 Business Auto Coverage 152400 0652321A 10/1/2024 10/1/2025 Pennsylvania Manufacturers' Assoc Ins,Co 12262 Y 100 Business Auto coverage 152400 06523218 10/1/2024 10/1/2025 Manufacturers Alliance ins Co 36897 Y 100 workers compensation 2024750652321 10/1/2024 10/1/2025 Pennsylvania Manufacturers' Assoc Ins CO 12262 Y 160 Excess Liability Coverage 7040440664 10/1/2024 10/1/2025 Columbia Casualty Company 31127 Y 100 The Subscribing insurers' obligations under contracts of insurance to which they subscribe are several and not joint and are limitedsolely to the extent of their individual subscriptions. The subscribing insurers are not responsible for the subscription of any co -subscribing insurer who for .any reason does not satisfy all or part of itsobligations. - ACORD 101 (2008101) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 00095965-5 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION - This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Of Additional Insured Person(s) Or Organization(s): Where required by written contract or written, agreement. ' I Information required to complete this Schedule if not shown above, will be shown in the Declarations. I 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 your acts or omissions or the acts or omissions. of those acting on your behalf. 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 00095965-5 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 Locations Of Covered Operations Where required by written contract or written agreement All operations of the Named Insured 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", 'property, This insurance does not apply to "bodily injury" or damage' or 'personal and advertising injury'property damage" occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts equipment furnished in,. connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf, maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to:such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. . CG 20 10 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 POLICY NUMBER: 00095965-5 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 Where required by written contract or written agreement All operations of the Named Insured 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. 0 CG 20 37 0413 Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: 00095965-5 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 2,of 2 POLICY NUMBER: 00095965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. . PRIMARY AND NON CONTRIBUTORY ENDORSEMENT' This endorsement modifies insurance provided under the following: ' ALL COVERAGE PARTS 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 written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. ' s a AP,5031 US O4-10 Page 1 of 1 POLICY NUMBER: 00095966-5 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 Penton Or Organization: Where required by written contract or written agreement 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 includedin 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 NUMBER: 00d95965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE LIMITS OF INSURANCE PER LOCATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION III -LIMITS OF INSURANCE -The General Aggregate Limit applies separately to each "Location" of the Named Insured. Notwithstanding the application of the General Aggregate Limit to each "Location" of the p r1 Named Insured, under no circumstances will we pay more than $10,000,000 for all claims under this policy that are subject to the General Aggregate limit. For the purpose of this endorsement, the following definition is added: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way,of a railroad. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5011US 12-03 Page 1 of 1 POLICY NUMBER: 00095965-5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE LIMITS OF INSURANCE PER PROJECT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS COMBINED LIABILITY POLICY SECTION III — LIMITS OF INSURANCE = The General Aggregate Limit applies separately to each "Project" of. the Named Insured. Notwithstanding the application of the General Aggregate Limit to each "Project" of the Named Insured, under no circumstances will we pay more than $10,000,000 for all claims under this policy that are subject to the General Aggregate limit. For the purpose of this endorsement, the following definition is added: "Project" means all work done by you or on your behalf, away from premises owned or rented to you, to complete an individual bid or negotiated contract to provide services for a specified period of time. Multiple jobs, work orders, purchase orders, or work done at multiple "locations" under one contract are not separate "projects" within the meaning of this coverage. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5012US 12-03 Page 1 of 1 POLICYNUMBER: 152400 0652321A COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE,POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY- OTHER INSURANCE ,CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage form and the Other Insurance —Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and' 2. You -have agreed in -writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such . "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and _ 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such' "insured". . CA 04 49 11 16 ©Insurance Services Office, Inc., 2016 INSURED COPY Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage .Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: 10/1/2024 SCHEDULE Name Of Person(s) Or Organization(s): -Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 AGENT POLICY NUMBER: 152400 0652321A COMMERCIAL AUTO PCA 05 04 0414 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER- OF RECOVERY RIGHTS This endorsement modifies coverage provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM We waive any right of recovery that we may .have against the person or organization shown in the SCHEDULE because of payments we make for injury or damage arising out of the operation of an. insured "auto", but such waiver is -only effective if the Named Insured has entered into a written contract or Name of Person or Organization: agreement with that person or organization, if such contract or agreement is made and dated prior to the injury or loss, and if such written contract or agreementrequires a waiver of recovery rights. This waiver applies only to the person or organization shown in the SCHEDULE below. SCHEDULE REQUIRED BY WRITTEN CONTRACT. PCA 05 04 0414 Includes copyrighted material of Insurance Services Office, Inc. with its permission The PMA Insurance Group, 2014 INSURED COPY Page 1 of 1 POLICY NUMBER: 202475 0652321 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE AS.',REQUIRED BY WRITTEN CONTRACT EXECUTED PRIOR TO, THE DATE OF LOSS. . 19M National Councll on Compenmtlon Usurance. INWRED COPY