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2018/07/01 ADP TotalSource DE IV, Inc. Certificate of Liability Insurance (3)°TIFI OF LIABILITY INSURANCE 706/05/18 TE (MYYY) 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 CONTACT Aon Risk Services, Inc or Florida NAME: Aon Risk Services, Inc of Florida 1001 Brickal! Bay Drive. Suite #1100 PHONE FAX Miami, FL 33131-4937 City Of NI e"I I F AIC, No, Ext : 800-743-8130 AIC No ; 800-522-7514 EMAIL City ADDRESS: ADP.COI.Centera@Aon.com INSURED ADP TotalSource DE IV, Inc. 10200 Sunset Drive Miarni, FL 33.73 IJCIF Keyser Marston Associates, Inc. 1299 Fourth Streot, Suite 408, San Rafael, CA 94901 COVFRAnFR INSURER(S) AFFORDING COVERAGE INSURER A.: American Home Assurance Co INSURER B : INSURER C : Received INSURER D : INSURER E : INSURER IF: CFRTIF1('.BTF NIIMFtF'R- gma9;F Ni NAIL # 1938!) 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. 1_Ih It s SH;:11AV /+RF AS R::01-IE ;T D. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POI -ICY PLUMBER POLICY EFF MM/DD/YYYY) POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL I_iAB!LITY EACH OCCURRENCE CLAIMS-MADI=. ❑ OCCUR FRDAMAGETORENTEC ED. ISES :a oacurrencel $ MED EXP (Any one arson PERSONAL & A INJURY $ GF:N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLIQY n PROJECT n LOC PRODUCTS - COMPIOP AGG S $ OTHER AUTOMOBILE LIABILITY COMBINED INGLE LIMIT Ea accident $ BODILY INJURY Per arson ANY AUTO OWNED —) SCHEDULED AUTOS ONLY i AUTOS BODILY INJURY (Per accident) S HIRED ; NON -OWNED PROPERTY DAMAGE AUTOS ONt.Y ! AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ AGGREGATE $ EXCESS I_IAB I I CLAIMS -MADE I DEC RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X _ PER Sl'Al'UTE 0'fH- LR E.L. EACH ACCIDENT S 2,000,000 A ANY PROPRIETORiPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A X WC 047018568 CA 7il/2018 7/1/2019 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Sea attached Certificate Holder Cancellation Notice. All workske employees working for KEYSER MARSTON ASSOCIATES, INC., paid under ADP TOTALSOURCE, INC's payroll: are covered under the above stated policy WAIVER OF SUBROGATION IN FAVOR OF CITY OF MENIFEE ITS OFFICERS. OFFICIALS, EMPLOYEES, AGENT, REPRESNTATIVES AND VOLUNTEERS AS RESPECTS OF JOB PERFORMED BY KEYSER MARSTON ASSOCIATES, INC AS REQUIRED BY WRITTEN CONTRACT. RE: Hotel Feasibility Study CERTIFICATE HOLDER CANCELLATION City of Menifae SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 29714 Haun Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monifee. CA 92586 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserve ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD rr: 1013106 This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following" attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement. Effective on 07/01/2018 at 12:01 AM, forms a part of Policy No. WC 047018568 Issued to: ADP TotalSource DE IV, Inc. 10200 Sunset Drive Miami, FL 33173 UC/F Keyser Marston Associates, Inc. 1299 Fourth Street, Suite 4.08 San Rafael, CA 94901 Premium: N/A By: American Horne Assurance Co. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be Additional Premium Percent% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job description City of Menifee RE: Sun City Core Retail Study its officers, officials, employees, agent, represntatives and volunteers 29714 Haun Rd Menifee, CA 92586 WC 04 03 06 Countersigned by (Ed. 4-84) Authorized Representative rArs 1013 POLICY HOLDER NOTICE (1'E1Zl,I]{ l(1'ATE HOLDER. CANCELLATION NOTWE SCH.I.DUTE Should this policy be cancelled before the expiration date hereof, the producer will endeavor to rnail 30 days written notice to the certificate holder named herein, but failure to do so shall impose no obligation or liability of any ldnd upon the insurer, the producer, or the respective agents or representatives of each. SCHEDULE: CEWrIFICA'T:E HOLDERS AS IDENTIFIED ON'T'HE MOST RECENT QUAR'TE'R1.:Y SCHEDULE OF CERTIFICATE HOLDERS PROVIDED BY THE INSURED'S BROKER OF RECORD TO THE INSURER. 1013106