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HomeMy WebLinkAboutA8566 - DUDEK, INC.ACORO® CERTIFICATE OF LIABILITY INSURANCE 8/282025 DATE(MMIDDNYYY) 08/26/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N 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 endoreement(s). PRODUCER Lockton Companies, LLC 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816)960-9000 RECEIVED kcasu@lockton.com PHONE EIMIL INSUREMS) AFFORDING COVERAGE NAIC0 INSURER A : Zurich American Insurance Company 16535 INSURED DUDEK S E P a 4 20,14 474583 605 THIRD STREET 92O024 OF THE CITY CLERK INSURER B: Continental Casualty Company 20443 INSURER C : NSURE INSURERR ED INSURER F COVERAGES CERTIFICATE NUMBER: 16837602 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. C I HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSO SUM WVD POLICY NUMBER POUCYEFF POLICYEXP MN1Ut&�V LIMITS A X COMMERCIAL GENERAL UABN GL 14 311 0828/202 08/28/202NCE $1 000 000 CLAIMS-MADE�OCCUR PREMISES u SIDDDDD e ersm _S1DY Y INJURY S 10000 0 AGGREGATE UNIT APPLIES PER �LOC EGATE S 2 000POLICY�JECT GEML MPIOP AGG $2000000 s OTHER: • AUTOMOBILE LIABILITY ELAP0146329 0828202 0828202 EO 81NNEED SINGLE LIMIT S 1,000,000 BODILY INJURY (Per parson) S XXXXXX XOYMJED ANY AUTO I SCHEDULED ONLY AUTOS y Y BODILY INJURY(Per aocidert S )Q(XXXX}(AUTOS OPERTY DAMAGE ra¢Wmt s XXXXXXX HIRED NON-OWNEDP AUTOS ONLY AUTOS ONLY $ XXXXXXX UMBRELLA LAB CUR NOT APPLICABLE EACH OCCURRENCE S XXXXXXX AGGREGATE $ X)0O = EXCESS LUI LAIMSJ.IADE DEC) I I RETENTION $ s WORKERS COMMNSATIO11 X A AND EMPLOYERS' LMSILTY YIN ANY PROPRIETORIPARTI,I ff CUrIVE AFFICE"EMBER E❑ %CLUfIED� N (Wndn n NH) NIA Y WC0146330 0828202 0828202 EL EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 11000,000 oE�RPaoN OF OPEa Ti eewr El DISEASEPOLICYLIMIT S 1,000,000 B PROFESSIONAL LIABILITY INCLUDES POLLUTION N N EEH5919328351NCL POLL 08/28202 08/28/2025 PER CLAIM $1 000,000 AGGREGATE 050,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addidonal Remarks Schedule, may be attached if more space is required) CITY AND ITS OFFICERS, COUNCIL MEMBERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL AND AUTO LIABILITY POLICIES. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED ON THE GENERAL, AUTO, AND WORKER'S COMPENSATION POLICIES. 30 DAYS NOTICE OF CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM. 16837602 CITY OF PALM SPRINGS 3200 E. TAHQUITZ CANYON WAY PALM SPRINGS CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE +.Ics ,ry J ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code: D574649 Certificate ID : 16837602 Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization ZURICH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLOO146311 Effective Date: 08/28/2024 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION ARE REQUIRED ALL TO PROVIDE ADDITIONAL INSURED STATUS IN LOCATIONS A WRITTEN CONTRACT, AGREEMENT OR PERMIT. U-GL-2169-A CW (02/19) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D574649 Certificate ID : 16837602 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 of this endorsement, 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 in such Schedule. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2169-A CW (02119) Page 2 of 2 Includes copyrighted material of Insurance services Office, Inc., with its permission. Attachment Code: D574648 Certificate ID : 16837602 Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add'I Prem. Return Prem. GL00146311 08/28/2024 08/28/2025 08/28/2025 37385000 S S INC L THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 'Be following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW (12101) Attachment Code : D574651 Certificate ID : 16837602 Coverage Extension Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AddT Prem Return Prem. BAP0146329 08/28/2024 08/28/2025 37385000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Includes copyrighted material of Insurance Services Office,, Inc., with its permission. U-CA-424-F CW (04-14) Page 1 of 6 Attachrpegb6j9dp6QP3MRjfiW1bf 11kilWtW Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-CA-424-F CW (04-14) Page 1 of 6 AttaWMRpEcj(CdOffifi iQc;lgW[LMW@6WS LIABILITY INSURANCE POLICY WC 00 03 13 WC0146330 Dudek 08/28/202408/28/2025 (Ed.4-84) 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 ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED. WC 00 03 13 (Ed.4-84) 0 1983 National Council on Compensation Insurance. <►`� o® CERTIFICATE OF LIABILITY INSURANCE 8/28/2025 DATE(MM/DDIYYYY) 8/26/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(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 endonsemen s . PRODUCER LOCktOn COmpaDICS, LLC 444 W. 47th Street, Suite 900 Kansas City MID 64112-1906 RECEIVED (816)960-9000 kcasu@lockton.com AUG 21 2024 CONTACT NAME: PHONE4. FAX No a1 EAIL ADDRESS: _ S AFFORDING COVERAGE MAIC8 INSURER A: ZuricINSURE h American Insurance Company 16535 I IMMIED DUDEK 1474583 605 THIRD STREET OFFICE OF THE CITY CLERK ENCINITAS CA 92024 INSURER B:Continental 20443 INSURERC: INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 16837602 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. INER L TYPE OF INSURANCE ADDL UBR pOl1GY NUMBER MPOLICY I Y EFF POLICY EXP llAllfS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx7 OCCUR Y Y GLOO146311 8282024 8282025 EACH OCCURRENCE $ 1 000 000 DAMAGE TO RENTI�D PREMISES a occurrence $ 100,000 MED EXP (Any one Person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2 OOO WO POLICY O PECT FX LOC PRODUCTS-COMP/OP AGG s 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY y y BAPo146329 8282024 8282025 E COMBINED t) GL LIM $ 1,000,000 BODILY INJURY (Per Person) s jp{7{}O{X,T{OWNED ANY AUTO I SCHEDULED AUTOS ONLY AUTOSHIRED BODILY INJURY(Per accident) S PROPERTY DAMAGE Par socidenl $ ' xx NON -OWNED AUTOS ONLY AUTOS ONLY $ XXX)= UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE S XXXXXXX AGGREGATE $ XXXXXXX EXCESS UAS CWMS-MADE DIED I I RETENTIONS s XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANV PROPRIETOR/PARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) IN Y WC0146330 8282024 1282025 PE MO X ST E ER El EACH ACCIDENT $ 1,000.0w E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT s 1,000,000 B PROFESSIONAL N N EEH591932835INCLPOLL 8282024 8282025 PER CLAIM$1,000,000 LIABILITY AGGREGATE $2,000,000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, AddNknal Remarks SCI may he albcMd R more draw Is rpui ad) CITY AND ITS OFFICERS, COUNCIL MEMBERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL AND AUTO LIABILITY POLICIES. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED ON THE GENERAL, AUTO, AND WORKER'S COMPENSATION POLICIES. 30 DAYS NOTICE OF CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16837602 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF PALM SPRINGS 3200 E. TAHQUITZ CANYON WAY AUTHORIZED REPRESENTATIV i PALM SPRINGS CA 92262 / ,I ACORD 25 (2016/03) © 1988(�015-ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment Code: D574649 Certificate ID: 16837602 Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ Policy No. GLOO146311 I Effective Date: 8/28/2024 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE ►j a ZURICH Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION ARE REQUIRED ALL TO PROVIDE ADDITIONAL INSURED STATUS IN LOCATIONS A WRITTEN CONTRACT, AGREEMENT OR PERMIT. U-GL-2169-A CW (02119) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Cade: D574649 Certificate ID: 16837602 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 of this endorsement, 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 in such Schedule. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2169•A CW (02119) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D574648 Certificate ID: 16837602 Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff. Date of Pol. I Exp. Date of Pal. I Eff. Date of End. I Producer I Add'1 Prem. Return Prem. GL00146311 8/28/2024 1 8/28/2025 8/28/2025 1 37385000 S INCL S THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-D Cw (12/01) Page 1 of 1 Attachment Code: D574651 Certificate ID: 16837602 Coverage Extension Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AddT Prem Retum Prem. BAP0146329 8/28/2024 8/28/2025 37385000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-CA-424-F CW (04-14) Page 1 of 6 P. Waiver of Transfer Of Rights Of Recovery Against Others To Us Attachment Code: D574651 Certificate ID: 16837602 The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Includes copyrighted material of Insurance services Office, Inc., with its permission. U-CA-424-F CW (04-14) Page 1 of 6 Attachment Code: D574650 Certificate ID: 16837602 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WC0146330 Dudek 8/28/20248/28/2025 (Ed.4-84) 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 ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED. WC 00 0313 (Ed. 4-84) 0 1983 National Council on Compensation Insurance. City of Palm Springs Engineering Services Department 3200 East Tahquitz Canyon Way • Palm Springs, California 92262 Tel: (760) 323-8253 • Fax: (760) 322-8360 • Web: www.palmspringsca.gov June 6, 2024 Dudek, Inc. ATTN: George Litzinger, P.E. 78-075 Main Street, Suite G-203 La Quinta, CA 92253 Re: Professional Services Agreement No. 8566 for On-Call Construction Management and Inspection Services Dear Mr. Litzinger, The referenced agreement expired on June 30, 2023, and in accordance with Section 3.4 of said Agreement may be extended at the discretion of the City Manager. This is to inform you that we wish to extend the Agreement for an additional year to June 30, 2025. This is the second of two (2) one-year extensions provided for in said agreement. If you have any questions or concerns regarding the extension of this Agreement, please contact me at your earliest convenience. Sincerely, Joel Montalvo City Engineer Approved by: _________________________________ _____________________________ Scott C. Stiles, City Manager Date Please sign to agree to extend Agreement 8566 for one (1) year ending June 30, 2025. __________________________________ _____________________________ Dudek, Inc. Date DocuSign Envelope ID: 560A6471-D593-409D-A6C9-41BBBE1B4173 6/6/2024 6/7/2024 ACORH CERTIFICATE OF LIABILITY INSURANCE 8/28/2023 DAM(SUNDWYYW) 8/17/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Lockton Companies 444 W. 47th Street, Suite 900 Kansas City M064112-1906 (816) 960-9000 CONTACT NME PHONE FAX E A/L No: E-MAIL ADDRESS'. kctsu@lockton.com INSURERS AFFORDWG COVERAGE NAICM INSURER A:Zurich American Insurance Company 16535 INSURED DUDEK INSURER B: Continpntal CaSlIaltyCompany 20443 INSURER C: 1474583 605 THIRD STREET SEP 2 8 2022 INSURER D : ENCINITAS CA 92024 INS {F BY BY............................... NSURER F: COVERAGES CERTIFICATE NUMBER: IISR37601 REVISION NUMBER: XXXXXXk' 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. ILTR NSR OF INSURANCE L AVOTYPE SUM POLICY NUMBER MUODIYri MMLIICD EXP LIMITS A �( COMMERGAL GENERAL LIABILITY CWMSMADE OCCUR Y Y GL00146311 8/28/2022 8/28/2023 EACH OCCURRENCE s 1000 000 PRE I ES Ea.ccune. S 100000 MED EXP (Any we person) S 10,000 PERSONAL S ADV INJURY S 1.000.000 GENLAGGREGATE LIMIT APPUES PER GENERAL AGGREGATE s 2000000 POLICY � JECCT [xi LOC PRODUCTS - COMPIOP AGG S 2,000,000 $ OTHER: A AUTOMOBILE UABIUTY y y BAP0146329 8/28/2022 8/28/2023 COMBINED ISINGLE LIMIT $ l UUO COU BODILY INJURY (Pal person) S �(� xxxxX ANYAUTO AUTOS ONLY AUTOSULED 1PROPX BODILY INJURY (Par accidenU S )(j(jt)(} X HIRED NON-OWNEAUTOS ONLY AUTOS ONLDY 11 ER Pe am�nOAMAGE $ XXXXXXX SXXXXXXX UMBRELLA UAS OCCUR NOTAPPLICABLE EACH OCCURRENCE S x7(}t} xxx AGGREGATE $ XXXXXXX EXCESS UAB CWMS�.IADE LIED RETENTION$ $ }(7(}(J(}(J(J( A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFIANY CERRAEM EOPRIETORPEXCLUDE09ECUTNE (Mandatary In NH1 N/A Y WC0146330 8/2$/2022 8/28/2023 EOTH- R STATUTE x T T TE ER E.L. EACH ACCIDENT $ I OOOOOO E.L. DISEASE -EA EMPLOYE $ 1000000 DESCRIPTION OF OPERATIONS beb E.L. DISEASE -POLICY LIMIT $ 1000000 B PROFESSIONAL N N EEH5919328351NCL POLL 9/28/2022 8/28/2023 PER CLAIM $1,000,0 ) LIABILITY AGGREGATE $2.000.000 INCLUDES POLLUTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACCRD 101, Additional Remarks Schedule, maybe attached a more space Is required) CITY AND ITS OFFICERS. COUNCIL MEMBERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL AND AUTO LIABILITY POLICIES. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED ON THE GENERAL, AUTO, AND WORKER'S COMPENSATION POLICIES. 30 DAYS NOTICE OF CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION See Attachments 16837602 CITY OF PALM SPRINGS 3200 E. TAH UITZ CANYON WAY Q 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. AUTHORDEO REPRESENTA ACORD 25 (2016/03) ©1988 015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment Code: D574649 Certificate ID: 16837602 Additional Insured — Owners, Lessees Or 9 Contractors — Scheduled Person Or Organization ZURICH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLOO146311 I Effective Date: 8/28/2022 Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION ARE REQUIRED ALL TO PROVIDE ADDITIONAL INSURED STATUS IN LOCATIONS A WRITTEN CONTRACT, AGREEMENT OR PERMIT. U-GL-2169-A CW (02/19) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D574649 Certificate ID: 16837602 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 of this endorsement, 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 in such Schedule. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2169-A CW (02/19) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D574648 Certificate ID: 16837602 Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. I Eff. Date of End. I Producer I Add'I Prem. Rem. Pre.. GL00146311 9/28/2022 8/28/2023 8/28/2023 1 37385000 IS INCL 5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW (12101) Page I of I Attachment Code: D574651 Certificate ID: 16837602 POLICY NUMBER: BAP0146329 COMMERCIAL AUTO CA 20 48 10 13 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: DUDEK Endorsement Effective Date: 8/28/2022 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Attachment Code: D574651 Certificate ID: 16837602 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 I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 2 of 2 Attachment Code: D574651 Certificate ID: 16837602 POLICY NUMBER: BAP0146329 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DUDEK Endorsement Effective Date: 8/28/2022 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMEDINSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Attachment Code: D574650 Certificate ID: 16837602 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WC0146330 Dudek 8/28/20228/28/2023 (Ed.4-84) 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 ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED. WC 00 03 13 (®d. 4-84) 1983 National Council on Compensation Insurance. AM(a ACORU® CERTIFICATE OF LIABILITY INSURANCE 8/28/2024 DATE(MMIDDIYYYY) 08/23/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER Lockton Companies PHONE 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 E-MAIL (816)960-9000 kcasu@lockton.com INSUR S AFFORDING COVERAGE NAIC0 INSURER A: Zurich American Insurance Company 16535 INSURED DUDEK INSURER B: Continental Casualty Company 20443 INSURER C : 474583 605 THIRD STREET ENCINITAS CA 92024 INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 16837602 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AD EN REDU ED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDL INSD SUB WVD POLICY NUMBER POUCY EFF POLICY MWD UP UMRS A X COMMERCIAL GENERAL LABILITY GLOO146311 0 2 081 8Y202 EACH OCCURRENCE $ 1,000,000 CWMS-MADE OCCUR PREMISES Ea =u"nou S 100000 MED UP (Any one person) $ 10,000 Y Y PERSONAL a ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JEC a LOC GENERAL AGGREGATE S 2,000,000 GENL PRODUCTS-COMP/OP AGG $ 2,000,000 s OTHER: A AUTOMOBILE LIABILITY BAP0146329 08/28/202 0812812024 CONI,SINENED SINGLE LIMIT jLa nll $ 1,000,000 X BODILY INJURY (Per person) $ XXXX)C(X MY AUTO OWNED SCHEDULED AUTOS ONLY AUTOSHIRED AUTOS ONLY ANUTNOSO ONLY y y BODILY INJURY (Per ac ent It XXXXXXX q Pe°a¢7> t AGE E XXXXXXX $XXXXXXX UMBRELLA UAB UR NOT APPLICABLE EACH OCCURRENCE $XXXXXXX AGGREGATE S XXXXX) x EXCESS UAB INMSAIADE DELI I I RETENTION $ S WORKERS COMPENSATION X A AND EMPLOYERS' LIABILRY YIN 00F(PROPRIETOWPARTN�ECU OFFICEMAEMBER EXCLUDED? psuwwry N NH) NIA Y WC0146330 OB/ M02 08/281202 EL EACH ACCIDENT Is 1.000.000 EL DISEASE - EA EMPLOYEE $ 1,000,000 ffm. v".rder DESCRIPTION OF OPEMTIONSE EL.DISEASE-POLICY LIMIT $ 1,000,000 B PROFESSIONAL LIABILITY INCLUDES POLLUTION N N EEH5919328351NCL POLL 08/28/202 08/28/2024 PER CLAIM $1 000000 AGGREGATE t2,060,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addieocel RemarlM Scheduls, may 0e attached R more space is required) CITY AND ITS OFFICERS, COUNCIL MEMBERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL AND AUTO LIABILITY POLICIES. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED ON THE GENERAL, AUTO, AND WORKER'S COMPENSATION POLICIES. 30 DAYS NOTICE OF CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16837602 AUTHORIZED REPRESENTATIVE CITY OF PALM SPRINGS 3200 E. TAHOUITZ CANYON WAY PALM SPRINGS CA 92262 1 "R% 07 1 / 01BUB-2015 ACORD CORPORATION. All nghts reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Attachment Code: D574649 Certificate ID : 16837602 Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLOO146311 This endorsement modifies insurance provided unde Commercial General Liability Coverage Part Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT. AGREEMENT OR PERMIT Effective Date: 08/28/2023 SCHEDULE WIN ZURICH Location(s) Of Covered Operations LOCATIONS U-GL-2169-A CW (02/19) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D574649 Certificate ID : 16837602 A. Section 11— Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule of this endorsement, 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 in such Schedule. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2169-A CW (02119) Page 2 of 2 Includes copyrighted material of Insurance services Office, Inc., with its permission. Attachment Code: D574648 Certificate ID: 16837602 Waiver Of Subrogation (Blanket) Endorsement Policy No. Eff. Date of Pol. Exp. Daze of Pot Eff. Date of End. Producer Add'1 Prem. Return Preto. GLOO146312 08/28/2023 08/28/2024 08/28/2024 3738S$00 S S INC L THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW (12101) Attachment Code : D574648 Certificate ID : 16837602 Page 1 of I Attachment Code: D574651 Certificate ID : 16837602 POLICY NUMBER: BAP0146329 COMMERCIAL AUTO CA 20 48 10 13 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: DUDEK Endorsement Effective Date: 08/28/2023 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Attachment Code: D574651 Certificate ID : 16837602 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 I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 2 of 2 Attachgng t§V 1UP§tVdAWo69L%ID : 16837602 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DUDEK Endorsement Effective Date: 08/28/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMEDINSURED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 AttaWORlII�EcbW6&PPMa QcA tvb*MWL86Y�##S LIABILITY INSURANCE POLICY WC 00 03 13 WC0146330 Dudek 08/28/202308/28/2024 (Ed.4-84) 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 ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED. WC 00 03 13 (Ed. 4-84) 0 1983 National Council on Compensation Insurance.