2020/04/01 Barrett Business Services, Inc. Certificate of Liability Insurance'`1t1t-'M"4111 CERTIFICATE OF LIABILITY INSURANCE DATE/YYYY)
Acct#: 2526403 3/20/2020/2020
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(lies) 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 endorsernent(s).
PRODUCER CONTACT
VViIlis of Greater Kansas City Inc. ME:
5700 W 112th Street, Ste. 100 PHONe . 844-290-4908 FAAAX
Overland Park, KS 66211 CITY OF MENIFEE Noll,
�� IL BBSlcerls@tocktonat5nity.com
FINANCE INSURE S AFFORDING COVERAGE NAIL 0
INSURER A : Ace American Insurance Co. 22667
INSURED 2020 INSURER B :
Barrett Business Services, Inc.
L/C/F ADAME LANDSCAPE INC. INSURER C.,
41863 JUNIPER STREET
MURRIETA, CA 92562 RECEIVED INSURER Di
MUR
INSURER E
INSURER F:
COVFRA(.FS r F=PTIGICATI= Al11MC2CG-
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.
INSR
LTR
TYPE OF INSURANCE
ODL
SUER
POLICY NUMBER
POLICY EFF
M DD/YYYY
POLICY EXP
MWDDIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$
DAEM
PREMT RE
ISES Ee rcence
$
MED EXP (Any oneperson)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO- ❑
JECT LOC
GENERAL AGGREGATE
$
PRODUCTS -COMP/OP AGG
$
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
ffaaccidentl
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS AUTOSWNED
PRgPERTY DAMAGE
il'�? 01}
$
_
UMBRELLA LAB
HOCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
Mandatory in (f yes, describe under
I
NIA
X
C66392454
4/1/2020
4/1/2021
_
X PER U E ERH
E.L. EACH ACCIDENT
$ 2,000,000
E.L DISEASE - EA EMPLOYE
$ 2,000,000
E.L DISEASE - POLICY LIMIT
$ 2.000.000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Policy State = CA
Blanket Waiver of Subrogation in favor of certificate holderwhen requred by written contract
RE: All Operations
City Of Menifee
29844 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.
AS
@ 1988-2014 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 ADAME LANDSCAPE INC.
41863 JUNIPER STREET
Symbol: Number: C66392454
MURRIETA, CA 92562
Policy Period
Effective Date of Endorsement
4/1/2020 TO 4/1/2021
4/1/2020
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
Authorized Agent
WC 99 03 22