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2016/04/01 Adame Landscape, Inc. Certificate of Liability InsuranceoR®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/31/2016 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 be endorsed. If SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME: Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699 Greenwopd Villa e 8011 j 0.Ity en�ue,e EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # - INSURER A: ACE American Insurance Company 22667 INSURED LU UINSURER Barrett Business Services, Inc. L/C/F B INSURER C ADAME LANDSCAPE INC-Received INSURER D: 41863 JUNIPER STREET INSURER E:— T_ MURRIETA, CA 92562 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 ISSUES 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY PROJ- LOC ECT S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS BODILY INJURY (Per person) S RSCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB OCCUR S DED RETENTION S A LIORKERSBILITY COMPENSATION AND EMPLOYERS' Y/N RWC C48807070 04/01/16 04/01/2017 �/ WC STATU- TORY LIMITS I OTH- ER ANY PROPRIETOR/PARTNER/ EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A Covered states: CA E.L. EACH ACCIDENT $2.000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Menifee y EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586,�J Richard Poling c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: RLJUI I IVIV/HL KCIVIAMM3 ---)U tLJULt Page 2 of 2 AGENCY NAMEDINSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48807070 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 04/01/16 AUUI I IONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Menifee ADDRESS: 29714 Haun Road Menifee CA 92586 Waiver of Subrogation applies in favor of The City of Manifee, its officers, employees, representatives, attorneys, and volunteers. City of Menifee Sun City Right of way Landscaping Project. 30 Day Notice of Cancellation notification will be provided when possible. AUUKU "I Ul (LUUd/U1) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L/C/F ADAME LANDSCAPING INC. Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Symbol: RWC Number: C48807070 Policy Period Effective Date of Endorsement 04-01-2016 TO 04-01-2017 04-01-2016 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $ 0 53:� Authorized Agent WC 99 03 22 oR®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/31/2016 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 be endorsed. If SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME: Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699 Greenwood Village, CO 80111 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: �� Barrett Business Services, Inc. L/C/F INSURER C: f ADAME LANDSCAPE INC. INSURER D: 41863 JUNIPER STREET INSURER E: MURRIETA, CA 92562 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 ISSUES 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG S POLICY LOC ECT ECT S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS B BODILY INJURY (Per accident) $ PROPERTY DAMAGE S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE $ $ DED RETENTION S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N RWC C48807070 04/01/16 04/01/2017 �/ WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNER/ EXECUTIVE Y OFFICER/MEMBER EXCLUDED?Covered (Mandatory in NH) If yes, describe under N/A states: CA E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Menifee EXPIRATION DATA THEREOF, NOTICE WILL BE POLICY PROVISIONS. DELIVERED IN ACCORDANCE WITH THE 29714 Haun Rd AUTHORIZED REPRESENTATIVE Sun City CA 925861_ Richard Poling c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: PL4JJLIJL L UUIII9/rqLm J%-,,A1 CLJ)Ul LC Page 2 of 2 AGENCY NAMEDINSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48807070 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 04/01/16 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Menifee ADDRESS: 29714 Haun Rd Sun City CA 92586 Project Name: Newport Road Widening Project ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/31/2n16 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 be endorsed. If SUBROGRATION 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 OnPoint Underwriting Inc. 8390 E Crescent Pkwy, Suite 200 Greenwood Village, CO 80111 INSURED Barrett Business Services, Inc. L/C/F ADAME LANDSCAPE INC. 41863 JUNIPER STREET MURRIETA, CA 92562 CONTACT NAME: Steven McComb PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699 EMAIL ADDRESS: F INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 _ INSURER B: INSURER C: -- INSURER D: INSURER E -- --- - ----- I INSURER F: UUVtKAUI=5 UtKIIFIGAILNUMBER: 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 ISSUES 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) S MED EXP (Any one person) s PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S POLICY PROJ- RLOC ECT S AUTOMOBILE LIABILITY - ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS BODILY INJURY (Per person) S RSCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE $ S DED RETENTION S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N RWC C48807070 04/01/16 04/01/2017 `/ WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNER/ EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A Covered states: CA E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT S2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Menifee Y EXPIRATION DATA THEREOF, NOTICE WILL BE POLICY PROVISIONS. DELIVERED IN ACCORDANCE WITH THE 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586, Richard Poling c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: o kW=d =11UULU= Page 2 of 2 AGENCY NAMEDINSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48807070 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 04/01/16 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Menifee ADDRESS: 29714 Haun Road Menifee CA 92586 RE: Haun Road Re -Beautification Project. 30 Day notice of cancelation will be provided when possible. CA Statutory Limits. ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/31/2016 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 be endorsed. If SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME: Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699 Greenwood Village, CO 80111 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Barrett Business Services, Inc. L/C/F INSURER C: ADAME LANDSCAPE INC. INSURER D: 41863 JUNIPER STREET INSURER E: _I� MURRIETA, CA 92562 INSURER F: I 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 ISSUES 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) S MED EXP (Any one person) $ PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG S POLICY PROJ- LOC S ECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS BODILY INJURY (Per person) $ RSCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE S DED RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 04/01/16 04/01/2017 WC STATU- OTH- LIABILITY Y/N C48807070 �/ TORY LIMITS ER E.L. EACH ACCIDENT S2,000,000 ANY PROPRIETOR/PARTNER/ EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A Covered states: CA E.L. DISEASE -EA EMPLOYEE S2,000,000 E.L. DISEASE - POLICY LIMIT S2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Menifee EXPIRATION DATA THEREOF, NOTICE WILL BE POLICY PROVISIONS. DELIVERED IN ACCORDANCE WITH THE 29714 Haun Rd. AUTHORIZED REPRESENTATIVE Menifee CA 92586a„^y Richard Paling c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: ADDMONAL REMARKS SCHEDULE AGENCY NAMEDINSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48807070 CARRIER ACE American Insurance Company ADDITIONAL REMARKS NAIC CODE 22667 JEFFECTIVE DATE: 04/01/16 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Menifee ADDRESS: 29714 Haun Rd. Menifee CA 92586 Page 2 of 2 Waiver of Subrogation applies in favor of City of Menifee. Job: Cherry Hills Area 3 - Menifee, Ca. 30 day notice of cancellation will be provided when possible. ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L/C/F ADAME LANDSCAPING INC. Policy Number 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Symbol: RWC Number: C48807070 Policy Period Effective Date of Endorsement 04-01-2016 TO 04-01-2017 04-01-2016 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $ 0 5:3:� Authorized Agent WC 99 03 22