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2021/07/01 ADP TotalSource DE IV, Inc. Certificate Number 3531249' k-. R CERTIFICATE OF LIABILITY INSURANCE DRTE[09/2021 �� 06I09/2021 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 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 Aon Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE I AX A/CM No Ext : 800-743.6130 {Arc, No}: 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 ADDRESS: ADP.COI.Cen[er cn,cam INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AIU Insurance Company 19399 INSURED ADP TotalSource DE IV, Inc. INSURER B INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D L/C/F Bruce E Mihelich Inc 7825 Indiana Ave, INSURER E INSURER F: Riverside, CA 92504 COVERAGES CERTIFICATE NUMBER: 3531249 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. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE INSR NSR SUER WVD POLICY NUMBER POLICY EFF MMD/YYYY /D POLICY EXP MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'LAGGRECAL TE LIMIT APPLIES PER: POLICY 171 PROJECT ❑ LOG OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Ea accident) $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC 038365707 CA 07/01/2021 07/01/2022 X STATUTE �RH E L. EACH ACCIDENT $ 2,000,000 E L DISEASE - EA EMPLOYEE $ 2,000,000 EL DISEASE -POLICY LIMIT $ 2.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) All worksite employees working for BRUCE E MIHELICH INC, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy 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 1IAc o 0F&.tida ©1988-2016 ACORD CORPORATION. All rights reserved_ ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 004720 90011444600 4 02 02 0 0000 0 000 1029825