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2018/01/01 ADP TotalSource DE IV, Inc. Certificate of Liability InsuranceA� CERTIFICATE OF LIABILITY INSURANCE MMIDDI DATE(2/28/128/1YYYY) 7 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 Aon Risk Services, Inc of Florida CONTACT Aon Risk Services, Inc of Florida NAME: 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 PHONE FAX A/C No Ext : 800-743-8130 A/C No): 800-522-7514 EMAIL ADDRESS: ADP.Col. Center Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Home Assurance Co. 19380 INSURED ADP TotalSource DE IV, Inc. INSURER B INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D : LIC/F Keyser Marston Associates, Inc. 1299 Fourth Street, Suite 408 INSURER E INSURER F : San Rafael, CA 94901 C OVERAUES CERTIFICATE NUMBER: 1833169 RFVIS10K] MI IMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLIC MMIDDY EFF POLICY EXP MMIDD/ LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE S DAMAGE TO RENTED PREMISES Ea occurrence S MED EXP (Any oneperson) S PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY Perperson) S ANY AUTO OWNED SCHEDULED BODILY INJURY Per accident S AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident S S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DEC I I RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC 026181717 CA 01/01/18 07/01/18 X PER OTH- STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' N / A X E.L. EACH ACCIDENT S 2,000,000 E.L. DISEASE - EA EMPLOYEE S 2,000,000 (Mandatory in NH) If yes, descnbe under E.L. DISEASE - POLICY LIMIT I S 2,000,000 DESCRIPTION OF OPERATIONS below TI t DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See attached Certificate Holder Cancellation Notice. All worksite 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: Sun City Core Retail Study CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Rd Menifee, CA 92586 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 oai��C {"�e�cv�ce3, q/zc V T 9StS-ZU15 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 12/28/2017 at 12:01 AM, forms a part of Policy No. WC 026181717 Issued to: ADP TotalSource DE IV, Inc. 10200 Sunset Drive Miami, FL 33173 UC/F Keyser Marston Associates, Inc. 1299 Fourth Street, Suite 408 San Rafael, CA 94901 Premium: N/A By: American Home 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 City of Menifee its officers, officials, employees, agent, represntatives and volunteers 29714 Haun Rd Menifee, CA 92586 WC 04 03 06 (Ed. 4-84) Countersigned by Job Description RE: Sun City Core Retail Study /!K, �J (3 � ��� � - Authorized Representative POLICY HOLDER NOTICE CERTIFICATE HOLDER CANCELLATION NOTICE SCHEDULE Should this policy be cancelled before the expiration date hereof, the producer will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to do so shall impose no obligation or liability of any kind upon the insurer, the producer, or the respective agents or representatives of each. SCHEDULE• CERTIFICATE HOLDERS AS IDENTIFIED ON THE MOST RECENT QUARTERLY SCHEDULE OF CERTIFICATE HOLDERS PROVIDED BY THE INSURED'S BROKER OF RECORD TO THE INSURER.