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2021/01/25 Barrett Business Services, Inc.ACaRD0 CERTIFICATE OF LIABILITY INSURANCE DATE/YYYY) Acct#: 2553748 1 /25/2025/2021 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 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($). PRODUCER Willis Towers Watson Midwest, Inc. 5700 W 112th Street, Ste. 100 U NIAL:I NAME: PHONE 844-290-4908 FAX c xO ' Overland Park, KS 66211 E-MAIL p ESS; BBSlcerts@locktonaffinity.com INSURERS AFFORDING COVERAGE NAIL tl INSURERA: Ace American Insurance Co. 22667 INSURED Barrett Business Services, Inc. INSURER B INSURER C: L/C/F HEARTLAND GRADING 3142 TIGER RUN COURT STE 114 CARLSBAD, CA 92010 INSURER D : INSURER E: 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. LTR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MMIDD IYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREJv11SES Ea occurrence $ . CLAIMS -MADE ❑.00CUR MED EXP (Anyoneperson) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ .1Ea F-1 LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT €aaccident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS INJURY Per accident) ( BODILY INJU$ HIREDAUTOS AONGOWNED PROPERTY $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X ER E.LEACH ACCIDENT $ 2,000,000 A ANY PROPRIETORIPARTNERfEXECUTIVE OFFICERIMEMI3EREXCLUDED? N/A X C68643582 2/1/2021 2/l/2022 E-L DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory In NH) 1[yyes, describe under DESCRMTION 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) Policy State = CA Blanket Waiver of Subrogation in favor of certificate holder when requred by written contract RE: All Operations. 30 day notice of cancellation will be provided when possible. CERTIFICATE HOLDER CITY OF MENIFEE 29714 Haun Road Menifee, CA 92586 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 © 1986.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Barrett Business Services, Inc. Policy Number L/C/F HEARTLAND GRADING 3142 TIGER RUN COURT STE 114 Symbol: Number: C68643582 CARLSBAD, CA 92010 Policy Period Effective Date of Endorsement 2/1/2021 TO 2/1/2022 2/1/2021 Issued By (Name of the Insurance Company) Ace American Insurance Co. 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: 3. Premium: The premium charge for this endorsement shall be INCLUDED 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: INCLUDED erxzlll,� Authorized Agent WC 99 03 22