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HomeMy WebLinkAboutA8345 - LIFESTREAM BLOOD BANK - BLOOD DRIVES AT VARIOUS RECREATION FACILITIESLIFEBL0-01 DVAN E ~ ACORD" ~ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6/27/2025 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 c onditions of the policy, certain policies may require an end orsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s . JUL 7 2025 INSURER S AFFORDING COVERAGE NAIC# 27960 INSURED 19682 Lifestream Blood Bank OFFICE Of THE CITY CLE ;-==RE=R_,,_C.:...: P_r_op=--e_rt..:.y_a_nd_Ca_s_u_al----=ty'----1-ns_u_ra_n_c_e_C_om--=-pa_n..:.y_o_f H_a_rtf_o_r_d_,_,,34=6~9 ~0 __ --J 384 West Orange Show Road San Bernardino, CA 92408 INSURERD : INSU RER 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. •rt: TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS oucn ''''"" A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 LJ CLAIMS-MADE CR] OCCUR X MLP G72559149 004 1/1 /2025 7/1 /2026 DAMAGE TO RENTED s 50,000 ,__ PREMISES (Ea occurren ,_, ,__ MED EXP CAnv one oersonl $ PERSONAL & ADV INJURY $ 1,000,000 ~ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ~ POLICY □ ~f8r □ LOC PRODUCTS • COMP/OP AGG $ 1 ,000,000 OTHER: ABUSE AND MOLES $ 1,000,000 B ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT ,,::, •~,.Aono\ $ 1,000,000 X ANY AUTO 51 UEN BF3722 7/1/2025 7/1 /2026 BODILY INJURY (Per personl s -OWNED ~ SCHEDULED .__ AUTOS ONLY -AUTOS BODILY INJURY /Per accidenll s X ~/ff3s ONLY X N&N-gWNE~ F~?~c\=:di;,'f,l~AMAGE s .___ ~ A TO ONL s A UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE s 10,000,000 X EXCESS LIAB CLAIMS-MADE X FL G72559150 004 1/1/2025 7/1 /2026 AGGREGATE $ 10,000,000 DED I I RETE NTION$ s C WORKERS COMPE NSATION X I ~ffruTE I I OTH- AND EMPLOYERS' UABlUTY ER Y I N 51 WN S89500 7/1 /2025 7/1 /2026 1 ,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ 8f:J~it~l~2t~ EXCLUD~D7 N I A 1,000,000 E.L. DISEASE~ EMPLOYEE $ ~ii•c~ftf(~ 'o1~PERATIONS below E.L D ISEASE • POLICY LIMIT l: 1,000,000 A Prof. Liability MLP G72559149 004 1/1/2025 7/1/2026 Aggregate Limit 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addition al Remarks Schedule, md be attached if more space is r equired) As required by written contract certificate holder(s) is included as additional insure to General Liability with regard to Blood Drives & related special events hosted by the named insured. Abuse & Mo lestation Aggregate Limit of Insurance: $1,000 ,000 s ublimit CERTIFICATE HOLDER City of Palm Springs its officers, agents and employees 3 Polaris Way 4th Floor 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CHUBB. nus ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorseme/11 Numb·er Blood Bank of San Bernardino and RiQerside Policy Symbol I Polley Number I PoGcy Period Effective Date MLP G72559149 004 01/01/2025 to 07/01/2026 01/01/2025 Issued Bv (Name of Insurance Company) Illinois Union Insurance Company Additional Insu red; Pri m ary,. N on-Contrbutory (Bla nket) This end orsem e n t modifies i n surance provided u nder the followin g: GENERAL LIABILITY C OV ERAGE PART (OCCURRENCE) Additional $ Included In consideration of the additional premium set forth above, if applicable, it is agreed that the coverage provided is a mended as follows: 1. The policy is amended by addi ng the following: a. At Section II. Who Is An Insured, by adding the following to Subsection B.: Any natural person or organization, if you are required by written contract to add such person or organ ization as an additional "insured", but solely with respect to such additional "insured(s)" liability for "bodily injury" or "property damage" caused by an "occurrence" that was caused solely by: i. You or your "employees" acting on your behalf; and ii. Within t he scope of your duties to a nd performed on behalf of such additional "insured"'. b. At Section V. Additional Conditions, by adding the following to the Other Insurance condition, Item 2: • Solely with respect to any such additional "insured" afforded coverage by this endorsement, if other valid insurance is available to such additional '"insured" for any liability covered by this endorsement, then : 1) This policy shall cover such liability on a primary basis; and 2) We will not seek contribution fr om such other valid insurance available to the addition al "insured", provided however, that subject to the General Aggregate Deductible a nd any Policy Aggregate Deductible shown in the Declarations, our obligations under this polky are excess of the Each "Occurrence" Deductible shown in the Declarations. 2.. The coverage affo rded by this e ndorsement to such additional "insured", shall be limited to "bodily injury", "property damage" or "personal and advertising inj ury" wh ich occurred or were committed after the written contract b etween such additional "insured" an d the Named Insured has been executed by both parties a nd such contract must be in effect during the Policy Period. Coverage for such additional ''insured" shall terminate as of the expiration of such written cont ract. 3. If the Lim its of Insurance stated in the Declarations exceed the limits of i nsura nce required by such written contract, then the in surance p rovided by this endorsement shall be limited to the limits of insurance requ ired by such wr itten contract. This endorsem ent shall not i ncrease the Limits of Insuran ce stated in the Declarations. 4 . The coverage p rovided shall not apply to a ny coverage under any Employee Be nefits Liability, Non-Owned Automobile Liability or Hired/Non-Owned Automob ile Liability endorsement(s) annexed to this policy. 5. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to such additional "insured(s)". Blood Bank of San Bernardino FAC Prim #1 (01/22) 339881 (01/22) Page 1 of 2 6. ·This endorsement only applies to and amends coverage under this policy, including any other Additional Insured(s) Endorsements thereto. If t his policy contains any other Additional Insured(s) Endorsements, then those endorsements remain in effect and are only amended by the terms of this endorsement. All other terms and conditions remain unchanged. Blood Bank of San Bernardino FAC Prim #1 (01/22) 339881 (01/22) Authorized Representative Page 2 o( 2 LIFEBLO-01 DVANCE � CERTIFICATE OF LIABILITY INSURANCE DATE(MM11E202YY) 12/3012024 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 RECEIVED Bush tone Insurance Services 9201 Camino Media Suite 250 Bakersfield, CA 93311 ��� f1U C �O^� D L C ^m Dawn Vance PHONE FAX (A/C. No. Est: (661 412-9099 An:, No): . dvance@acrisure.com INSURER(SI AFFORDING COVERAGE NAIC 0 INSURER A: Illinois Union Insurance Company 27960 RISURED Blood Bank of San Bemardino and Riverside Counties dba: mSORER a artford !Ire lnsti! nce Com n 19682 INsuRER C: Property and Casualty Insurance Company of Hartford 34690 LifeStream 384 West Orange Show Road INSURER D: San Bernardino, CA 92408 INSURERE: 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 A130VL FUK I nt rUuOr rEKlw 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 ADOLSUBR POLICY NUMBER POLICY EFF POLICY EXP L1MR3 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X MLP G72559149 004 111/2025 7/1/2026 TO RENTED DPREMISES tEiloolarrit —1 ItAMAGE 50,000 MED EXP (Any oeperson) PERSONAL & ADV INJURY 3 11000,000 GEN'L AGGREGATE LIMpIT. APPLIES PER: X POLICY JEpCT LOC GENERAL AGGREGATE 3,000,000 PRODUCTS-COMP/OPAGG 11000,000 IABUSE AND MOLES 11000,000 OTHER B LIABILRY COMBINED SINGLE LIMIT 11000,000 BODILY INJURY PerNEDSCHEDULED YAUTO51 UEN SF0430 1213112024 12/3112025 BODILY INJURY Peraccident rOBILE TosONLYAUTTOSS E ONLY AUTOS ONNL� TOSON PR EElr ne DAMAGE A UMBRELLAuAB X OCCUR EACH OCCURRENCE 10,000,000 EXCESS LIAR CLAIMS -MADE XFL G72559150 004 1/1/2025 7f1/2026 X 1-1 AGGREGATE DED RETENTION $ C WORKERS COMPENSATION ANOEMPLOYERS'LUIBIUTY YIN ANY PROPRIETORIPARTNER/EXECUTNE ❑ Q aFn'5 WW MaW EXCLUDED? IM NN) NIA 51 WN S89500 7/1/2024 X PER OTH- STATUTE I I ER 711/2025 E.L. EACH ACCIDENT E. L. DISEASE - EA EMPLOYE M3,"'00000,"0000 It yes, describe under DESCRIPTION OF OPERATIONS bebw E.L. DISEASE - POLICY LIMITp Prof. Liabiliity J MLP G72559149 004 1/1/2025 7/1/2026 Aggregate Limit DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD tilt, Additional Remarks Schedule, may 1,e attached R more space is required) As required by written contract certificate holder(s) is Included as additional insured to General Liability with regard to Blood Drives & related special events hosted by the named insured. Abuse & Molestation Aggregate Limit of Insurance: $1,000,000 sublimit City of Palm Springs its officers, agents and employees 3 Polaris Way 4th Floor 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 ACORD 25 (2016103) 9 198a-ZU10 AL.UKU t.UKI'UKA I IUIN. All rig ❑ s reserveo. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Entlmement Number Blood Bank of San Bernardino and Rio erside Policy Symbol Policy Number Policy Period Effective Daie MLP G72559149 004 01/01/2025 to 07/01/2026 01/0112025. Issued By (Name of Insurance Companv) Illinois Union Insurance Company Additional Insured; Primary, Non-Contrbutory (Sianket) This endorsement modifies insurance provided under the following: --GENERAL-LL4,BILITYCOVERAGE PART (OCCURRENCE) -- - --- - ---- - Additional $ Included In consideration of the additional premium set forth above, if applicable, it is agreed that the coverage provided is amended as follows: 1. The policy is amended by adding the following: a. At Section II. Who Is An Insured, by adding the following to Subsection B.: Any natural person or organization, if you are required by written contract to add such person or organization as an additional "insured", but solely with respect to, such additional "insured(s)" liability for "bodily injury" or "property damage" caused by an "occurrence" that was caused solely by: L You or your "employees" acting on your behalf; and ii. Within the scope of your duties to and performed on behalf of such additional "insured". b. At Section V. Additional Conditions, by adding the following to the Other Insurance condition, Item 2: Solely with respect to any such additional "insured" afforded coverage by this endorsement, if other valid insurance is available to such additional "insured" for any liability covered by this endorsement, then: 1) This policy shall cover such liability, on a primary basis; and 2) We will not seek contribution from such other valid insurance available to the additional 'insured", provided however; that subject to the General Aggregate -Deductible and any Policy Aggregate Deductible -- shown in the Declarations, our obligations under this policy are excess of the Each "Occurrence" Deductible shown in the Declarations. 2.. The coverage afforded by this endorsement to such additional "insured", shall be limited to "bodily injury", "property damage' or "personal and advertising injury" which occurred or were committed after the written contract between such additional "insured" and the Named Insured has been executed by both parties and such contract must be in effect during the Policy Period. Coverage for such additional "insured" shall terminate as of the expiration of such written contract. 3. If the Limits of Insurance stated in the Declarations exceed the limits of insurance required by such written contract, then the insurance provided by this endorsement shall be limited to the limits of insurance required by such written contract. This endorsement shall not increase the Limits of Insurance stated in the Declarations. 4. The coverage provided shall not apply to any coverage under any Employee Benefits Liability, .Non -Owned Automobile liability or Hired/Non-Owned Automobile Liability endorsement(s) annexed to this policy. 5. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to such additional "insured(s)". Blood Bank of San Bemardino FAC Prim #1 (01/22) 339881 (01/22) Page 1 of 6. -This endorsement only applies to and amends coverage under this policy, including any other Additional Insured(s) Endorsements thereto. If this policy contains any other Additional Insured(s) Endorsements, then those endorsements remain in effect and are only amended by the terms of this endorsement. All other terms and conditions remain unchanged. Authorized Representative Blood Bank of San Bernardino FAC Prim #1 (01/22) 339881 (01/22) Page 2 of 2 MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY OF PALM SPRINGS AND LIFESTREAM THIS MEMORANDUM OF UNDERSTANDING (the "Memorandum of Understanding or MOU") dated May 15, 2019 (the "Effective Date") is by and between the City of Palm Springs, a California Municipal Corporation, (hereinafter ""City""), and LifeStream Blood Bank, a non-profit 501(c)(3) corporation ("LifeStream"), with reference to the following facts: A. The parties seek to provide several blood drives throughout the City in order to achieve the agreed upon projection/goal; B. The parties' projection/goal is a commitment by the Parties to local hospitals; C. LifeStream will provide all equipment required to host a successful blood drive; D. City will provide a facility for LifeStream to set up its bloodmobile at least 3 times per calendar year at each City facility; and E. The parties intend by this Memorandum of Understanding to memorialize the nature of their respective roles, promises and obligations relating to their blood donation commitment to the hospital. NOW THEREFORE, based on the recitals set forth above, City and LifeStream agree as follows: I. INTENTION AND PURPOSE The intention of this Memorandum of Understanding is to memorialize the Parties' roles, promises, and obligations to each other in their common commitment to provide hospitals with the agreed upon projected blood donation. II. TERM The term of this MOU shall be for a period of one year with three one year extensions if the parties agree. III. PARTY OBLIGATIONS A. City's Obligations. In addition to all other obligations set forth in this Memorandum of Understanding, City shall have the following obligations: 1. Provide and secure dedicated parking area in advance for bloodmobile and easy up tent, along with designated parking for donors; 2. Provide restroom access for staff and donors; and 55575.00001\31997381.2 3. Actively help spread the word in the community using the resources LifeStream provides (i.e. online registration, hard copy marketing flyers, social media. B. LifeStream's Obligations. In addition to all other obligations set forth in this Memorandum of Understanding, LifeStream shall have the following obligations: 1. Provide a 36 foot by 15 foot bloodmobile to collect 1 unit of whole blood from interested and eligible donors; 2. Provide all of the equipment required to host a successful blood drive, including juice, water and snacks for canteen; 3. Work jointly with City to confirm a time, date, and location schedule staffing, create and print inviting collateral materials; 4. Provide donors a Donor ID Card with their photo and blood drive approx. 4-6 weeks after the drive; and 5. Provide free mini physicals (i.e. iron, blood pressure and after the blood drive Cholesterol level) to each donor. IV. CITY FACILITIES The City agrees to make the following City facilities available for LifeStream to provide LifeStream's services. City also agrees to make each facility available for at least 3 blood drives per calendar year as mutually agreed to by the Parties' staff. A. James O. Jessie Desert Highland Unity Center 480 W. Tramview Rd. Palm Springs, CA 92262 B. Demuth Community Center 3601 E. Mesquite Ave. Palm Springs, CA 92264 C. Villagefest 100 North Palm Canyon Dr. Palm Springs, CA 92262 V. INDEMNIFICATION A. . LifeStream. LifeStream shall indemnify, defend and hold the City harmless from any and all claims, costs and liability for any damage, injury or death of or to any person or the property of any person, including attorneys' fees, to the extent arising out of or in connection with the willful misconduct or the negligent acts, errors, or omissions by LifeStream, its officers, agents or employees with respect to LifeStreams's performance of this MOU. 55575.00001\31997381.2 B. The City. City shall indemnify, defend and hold LifeStream harmless from any and all claims, costs and liability for any damage, injury or death of or to any person or the property of any person, including attorneys' fees, to the extent arising out of or in connection with the willful misconduct or the negligent acts, errors, or omissions of the City, its officers, agents or employees with respect to the City's performance under this MOU. VI. NOTICES Any party delivering notice or requesting information from the other shall send such notice or request as indicated below: Cam: City of Palm Springs Attention: Cynthia Alvarado 401 S. Pavilion Way Palm Springs, CA 92262 LifeStream: LifeStream Attention: Scott Miller 384 West Orange Show Road San Bernardino, CA 92408 VII. TERMINATION This MOU may be terminated by either party with a thirty (30) day notice to the other party. VIII. COUNTERPARTS This Memorandum of Understanding may be executed in any number of counterparts, each of which shall be deemed an original, but all of which when taken together shall constitute one and the same instrument. The signature page of any counterpart may be detached therefrom without impairing the legal effect of the signature (s) thereon provided such signature page is attached to any other counterpart identical thereto except having additional signature pages executed by other parties to this Memorandum of Understanding attached thereto. IX. SEVERABILITY If any term, covenant or condition of this Memorandum of Understanding shall, to any extent, be invalid, void, illegal or unenforceable, the remainder of this Memorandum of Understanding shall not be affected thereby, and each other term, covenant or condition of this Memorandum of Understanding shall be valid and be enforced to the fullest extent permitted by law. 55575.00001\31997381.2 X. GOVERNING LAW This Memorandum of Understanding is made and entered into in the State of California and shall be governed by and construed and enforced in accordance with the laws of the State of California. The venue for resolving any disputes regarding this MOU shall be within the County of Riverside. XI. AMENDMENT No modification, variation or amendment of this Memorandum of Understanding shall be effective without the written consent of all of the parties to this Memorandum of Understanding at the time of such modification, variation or amendment. XII. SUCCESSORS This Memorandum of Understanding shall be binding on and inure to the benefit of each of the parties' successors and assigns. XIII. ATTORNEYS' FEES In any action or proceeding brought to enforce any provision of this MOU, or where any provision hereof is validly asserted as a defense, the successful party shall be entitled to recover reasonable attorneys' fees and court costs in addition to any other available remedy. [THE REMAINDER OF THIS PAGE WAS INTETIONALLY LEFT BLANK] 55575.00001\31997381.2 IN WITNESS WHEREOF,the parties have executed this Memorandum of Understanding on f* *MONTH,DAY***l 2019. LifeStream Blood Bank City of Palm Springs, a California municipal Corporation 1 By: B �� _ David Ready,Esq. V P/L OW ATT T: By: BY thony jia City Cler APPROVED AS TO FORM: APPROVED AS TO FORM: By: By: Q/7/�l, �v est st&Wieger LLP Legal Counsel City Attorney 55575.00001\31997381.2 I.i1ternal F,evi)Yue service EP!EQ DisnlosUre Desk P . O. Box 2350 Los Auglies, CA 9GOS3 Person to 0asYtact : F - 14iraf10r or L . B.a� rajar, BLQ01D .iB-I'O K OF SAN B`ERN FDINO Ttalepho.Ye Nexrria-jer : AND nIVERSIDS COUNTIES INC Cris ? =14-4132 P.G. D_,X 2729 Refer Reply to , t OCT 30 1990 RE : 95,1 7a8 7 43 BLOOD SANK F SAN PER:NA DINS ` AMD RIVERSIDE CC)C'I'vTIP,S INC This Q Xls,PaO ti^ f0 YOtt.". revi';..ins t for a det;:r7iiini f 3 c-fL ietter of the above-named organiiation.. F: reXitW of our records iscdi.onte-s t'dYut t;.e *,.b-3v%-.--naYred Cr{ ,ntsation was zeon ni2sd to he vneq}t jrym Fr L"',e;yaj .iiCC.m,—f sntr..hal VFir:•nue C.04.w. section It 1 :i further glas-sified as an organiz li n that is not I private fou da " i:n os defined in suction 509( ) (It t.!le code , it _ : an organizatinn rescril.>ed in pecticy 50900 ( j) . This 1 e t tvr is to vAr i r,y your -exemI.'?.'i s to tu._-. and the. fact that the WetC$;'nhnat io.n letter . =ue% cis APRIL , 1952 continues to be in effect . W -Vott age in reed of further assistance , please fasts tree to robtaL t ms at the above addless . We appreciate your: Cooper_atload in this r4ge, ci' Sincere 1 y , Lti. scl "rst;r� Assistant. DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 11/1/2019 5/1/2019 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 Lockton Companies NAME: 8110 E Union Avenue PHONE FAX Suite 700 MAIL Ext: AC, C No- Denver CO 80237 ADDRESS: (303)414-6000 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Self Insured Retention INSURED Blood Bank of San Bernardino INSURER B:Sentry Insurance a Mutual Company 24988 1454980 and Riverside Counties INSURER C:Sentry Casualty Company CompaLly 28460 dba LifeStream INSURER D:Illinois Union Insurance Company 27960 PO Box 1429 INSURER E: San Bernardino,CA 92402-1429 INSURER F COVERAGES CERTIFICATE NUMBER: 16050992 REVISION NUMBER: XXXXXXX 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 EFF POLICY EXP LIMITS LTR I D D POLICY NUMBER MMIDD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X Y N Self Insured Retention 11/I/2018 11/1/2019 DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence S XXXXXXX X Prof.Liab Clms Made MED EXP(Any one person) s XXXY,-XXX $IM each incident PERSONAL&ADV INJURY S XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S XXXXXXX POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ XXXXXXX X OTHER: I S B AUTOMOBILE LIABILITY Y jai 90-04101-02 11/1/2018 11/I/2019 Ee aBINEDtSINGLE LIMIT S 1,000,000 X ANY AUTO BODILY INJURY(Per person) S XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS XXXXXXX HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUTOS ONLY Per accident s ==XX D UMBRELLA LIAB X OCCUR Y N XFLG7119839AO01 11/l/2018 11/1/2019 EACH OCCURRENCE S 10,000,000 X EXCESS LIAB X I CLAIMS-MADE AGGREGATE S 10,000,000 DED RETENTIONS S XXXXXXX WORKERS COMPENSATION OTH- C AND EMPLOYERS'LIABILITY Y/N Y 900410101 11/1/2018 11/1/2019 X I STATUTE I ER ANY C OFFICERIMEMBEREXCLUDED?ECUTIVE 7 N/A 900410104 11/1/2018 II/l/2019 E.L.EACH ACCIDENT S 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under I DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1.000 000 D GL/AL/EL-Occ N N XFLG7119839A001 11/I/2018 I I/l/2019 $5,000,000 Aggregate Prof.Liab.-CM $5,000,000 Each Incident Retro Date 1-1-02 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. *Actual limits may be greater than those shown.Certificate Holder is Additional Insured as respects General Liability,Auto Liability and Excess Liability on a primary and non-contributory basis where and if required by written contract or agreement with regard to Any and All Blood Drives and Related Special Events hosted by the Named Insured.As respect to all coverage lines referenced above,Waiver of Subrogation applies in favor of the Additional Insured where and if required by written contract or agreement and as permitted by law. The following is/are included as Additional Insured:The City of Palm Springs,its officers,officials,employees and volunteers. CERTIFICATE HOLDER CANCELLATION See Attachments 16050992 City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Attn: City Clerk ACCORDANCEIWITH THE POLICY PROVISIONS. ON DATE THEREOF, E WILL BE DELIVERED IN PO Box 2743 Palm Springs CA 92262 AUTHORIZED REPRESENTATIVE ©1988-20 t ACORb CORPdhATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code:D557476 Master ID: 1454980,Certificate ID: 16050992 THIS ENDORSEMENT CHANGES YOUR POLICY.PLEASE READ IT CAREFULLY. Named Insured Endorsement Number Vitalant 7 Policy Symbol Policy Number Policy Period Effective Date XFL G7119839A 001 11/01/2018 to 11/01/2019 11/01/2018 Issued By(Name of Insurance Company Illinois Union Insurance Company ADDITIONAL INSURED(S)WRITTEN CONTRACT ENDORSEMENT (COMMERCIAL GENERAL LIABILITY) It is understood and agreed that SECTION C. DEFINITIONS, subsection T. Insured, paragraph 5. is amended to include the following: • Any natural persons or entity(ies) with whom or which the named insured has a written contract: (1) in effect during the policy period; (ii) executed prior to the bodily injury or property damage occurring, and (III)that requires that this policy include such natural person or entity as an additional insured hereunder. However, coverage for such additional insured is limited as follows: 1) Such natural person or entity is an insured only for bodily injury or property damage caused by an occurrence that was caused solely by: i. the named insured or its employees acting on the named insured's behalf;or ii. duties performed by such additional insured on behalf of the named insured and within the scope of such additional insured's written contract or agreement with the named insured; 2) This coverage shall not apply to any occurrence that takes place prior to the effective date of the written contract or after such contract is terminated,canceled or expires; 3) If the Limits of Liability stated in the Declarations exceed the Limits of Liability required by such contract, the insurance provided by this endorsement shall be limited to the Limits of Liability required by such written contract. This endorsement shall not increase the Limits of Liability set forth in Item 5. of the Declarations page; 4)This coverage shall not apply to any liability arising out of the sole negligence of such additional insured. Where no coverage would apply under this policy for the named insured, no coverage or defense shall be afforded to such additional insured;and 5) Unless otherwise required by the named insured in accordance with the written contract or written agreement with the named insured,the coverage hereunder shall be excess of, and not contribute with, any other insurance available to any additional insured, whether primary, excess, contingent, or available on any other basis. All other terms and conditions of this policy remain unchanged. Posldol Authorized Representative PF-27919a(06/16) Page 1 of 1 (ECI ERODING,ECI PRO-RATA,EC EXCLUDED) Includes copyrighted material of Insurance Services Office,Inc.with its permission. Attachment Code:D557482 Master ID: 1454980,Certificate ID: 16050992 CHUM THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Named Insured Endorsement Number Vitalant 13 Policy symbol Policy Number Policy Period Effective Date XFL G7119839A 001 11/01/2018 to 11/01/2019 11/01/2018 Issued By(Name of Insurance Company Illinois Union Insurance Company Blanket Waiver Of Subrogation (Written Contract) This endorsement modifies insurance provided under the following: HEALTHCARE FACILITIES EXCESS LIABILITY POLICY Additional Premium: S Included In consideration of the additional premium set forth above,if applicable,it is agreed that the following is added to SECTION F. CONDITIONS,paragraph G. Subrogation: We waive any right of recovery for payments made under this policy that we may have against any person, organization,or entity with which the insured agrees in writing,provided that: 1. the insured's written agreement with such person,organization,or entity requires that the insured waives his or her right to recover all or part of any payments that we make under this policy; and 2. the insured's written agreement with such person,organization,or entity was executed by both the insured and the person,organization,or entity,and was in effect prior to the time of the damages. This waiver applies only with respect to the specific written agreement existing between the insured and the person,organization,or entity and shall not be construed to be a waiver with respect to other operations of such person,organization,or entity in which the insured has no written or contractual interest. All other terms and conditions remain unchanged. Authorized Representative Vitalant FAC SAXS#2(11/18) 268569 copyright Page 1 of 1 Attachment Code:D557522 Master ID: 1454980,Certificate ID: 16050992 CHUBB@ THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Named Insured Endorsement Number Vitalant 3 Policy Symbol T Policy Number Policy Period Effective Dale XFL G7119839A 001 11/01/2018 to 11/01/2019 11/01/2018 Issued By(Name of Insurance Company Illinois Union Insurance Company Additional Insured -Primary, Non-Contributory (Written Contract)) This endorsement modifies insurance provided under the following: HEALTHCARE FACILITIES EXCESS LIABILITY POLICY In consideration of the premium paid,it is agreed that the policy is amended as follows: 1. The policy is amended by adding the following: a. At SECTION C. DEFINITIONS, by adding the following to paragraph T. Insured with respect to Section B. Stand Alone Excess Liability only: Any person, organization, or entity with which the insured agrees in writing to add as additional insured(s) shall be considered additional insured(s), but solely with respect to such additional insured(s)' liability caused by a loss event that was caused or committed solely by: (1) you or your employees acting on your behalf;and (2) within the scope of your duties to and performed on behalf of such additional insured. b. At SECTION F.CONDITIONS,by adding the following to Condition II.B..Other Insurance; Solely with respect to any additional insured afforded coverage by this endorsement,if other valid insurance is available to such additional insured for any liability covered by this endorsement,then: (1) this policy shall cover such liability on a primary basis;and (2) we will not seek contribution from such other valid insurance available to the additional insured, provided however, that subject to any applicable Aggregate Deductible(s) shown in the Declarations, our obligations under this policy are in excess of any Each Incident Deductible shown in the Declarations. 2. The coverage afforded by this endorsement to such additional insured, shall be limited to loss events which occurred or were committed after the written contract between such additional insured and the Named Insured has been executed by both parties and such contract must be in effect during the Policy Period. Coverage for such additional insured shall terminate as of the expiration of such written contract. 3. If the Limits of Insurance stated in the Declarations exceed the limits of insurance required by such written contract,then the insurance provided by this endorsement shall be limited to the limits of insurance required by such written contract.This endorsement shall not increase the Limits of Insurance stated in the Declarations. 4. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to such additional insured(s). 5. This endorsement only applies to and amends coverage under this policy,including any other Additional Insured(s) Endorsements thereto,for those additional insureds described above.If this policy contains any other Additional Insured(s)Endorsements,then those endorsements remain in effect and are only amended by the terms of this endorsement with respect to those additional insureds described above.Coverage for any additional insureds not described above remains unchanged. Vitalant FAC SAXS#1 (11/18) 268565 Copyright Page 1 of 2 Attachment Code:D557522 Master ID: 1454980,Certificate ID: 16050992 All other terms and conditions remain unchanged. Authorized Representative Vitalant FAC SAXS#1 (11/18) 268565 Copyright Page 2 of 2 Attachment Code:D557483 Master ID: 1454980,Certificate ID: 16050992 COMMERCIAL AUTO WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: Business Auto Coverage Form SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY A WRITTEN CONTRACT TO WAIVE RECOVERY RIGHTS. Section IV BUSINESS AUTO CONDITIONS A. Loss Conditions 5. Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: 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, loss or damage rising out of your ongoing operations or your work done under a contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. CA 80 11 07 07 VIT 90-04101-02 00 181 11-14-18 PAGE 001 00009 Miscellaneous Attachment:M557500 Master ID: 1454980,Certificate ID: 16050992 COMMERCIAL AUTO ADDITIONAL INSURED -AUTOMATIC STATUS WHEN REQUIRED BY CONTRACT OR AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM A. Section II. Liability A. Coverage 1. Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. The status of an additional insured under this endorsement ends when your operations for that additional insured are completed. B. The most we will pay on behalf of the additional insured is the lesser of the amount payable under Section C. Limit Of Insurance or the amount of insurance required by the contract or agreement. C. Notwithstanding any requirement,term or condition of any contract or agreement with respect to which this endorsement may pertain,the insurance afforded to the additional insured is subject to all the terms, exclusions and conditions of the Commercial Auto Coverage Form to which this endorsement is attached. CA 80 07 02 06 VIT 90-04101-02 00 181 11-12-18 PAGE 001 00255 Attachment Code:D557512 Master ID: 1454980,Certificate ID: 16050992 WORKERS'COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-04101-01 00 181 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 any one not named in the Schedule. Schedule ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS. WC 00 03 13(Ed.04-84) Copyright 1983 National Council on Compensation Insurance. VIT 90-04101-01 00 181 VITALANT 11-09-18 PAGE 001 00255 Attachment Code:D557513 Master ID: 1454980,Certificate ID: 16050992 WORKERS'COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER:90-04104-01 00 181 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 contractthat requires you to obtain this agreement:from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS. WC 00 03 13(Ed.04-84) Copyright 1983 National Council on Compensation Insurance. VIT 90-04101-04 00 181 VITALANT 11-09-18 PAGE 001 00317