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2021/07/01 ADP TotalSource DE IV, Inc. Certificate Number 3540616TE;MY1rYYj -_ 4I. = �r'� CERTIFICATE OF LIABILITY INSURANCE rO6/09/2021 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 endorsements . PRODUCER Aon Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida AIC No Ext : 800-743-8130_FrA/C. No): 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 EMAIL ADDRESS: ADP.COI.Cenit r an.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AU Insurance Company 19399 INSURED ADP TotalSource DE IV, Inc. INSURER B INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D L/C/F W C Healing & Air Conditioning Inc DBA We Care 41085 Golden Gale Cur, INSURER E INSURER F Murries, CA 92562 COVERAGES CERTIFICATE NUMBER: 3540616 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF YY (MM/DD/YY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LiAMLITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PPOLICY1:1 PROJECT ❑ LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY C BINED IN L L1M1T Ea accident $ BODILY INJURY Per arson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC I I 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 X WC 038365657 CA 07/01/2021 07/01/2022 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E L DISEASE - POLICY LIMIT 1 $ 2,000,000 1 .1. 1 T___ I T I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for W C HEATING & AIR CONDITIONING INC DBA WE CARE, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. See attached Certificate Holder Cancellation Notice. WAIVER OF SUBROGATION IN FAVOR OF CITY OF MENIFEE AS RESPECTS OF JOB PERFORMED BY W C HEATING & AIR CONDITIONING INC DBA WE CARE AS REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and its officers, employees, agents, and authorized volunteers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29844 Haun Road Menifee, CA 92586 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (7401Z CL�k (JEtviceL, IQ/=O Of L-�_109EidfL (c)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD r�C�t 023361 90011508900 6 04 02 0 0000 0 000 1048204 Certificate Number: 3540616 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 07/01/2021 at 12:01 AM, forms a part of Policy No. WC 038365657 Issued to: ADP TotalSource DE IV, Inc. By: AIU Insurance Company 10200 Sunset Drive Miami, FL 33173 L/C/F W C Heating & Air Conditioning Inc DBA We Care 41085 Golden Gate Cir Murrieta, CA 92562 Premium: N/A 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 and its officers, employees, agents, and authorized volunteers 29844 Haun Road Menifee, CA 92586 WC 04 03 06 (Ed. 4-84) Countersigned by Job Description Authorized Representative 023361 90011508900 6 09 03 0 0000 0 000 1048204 Certificate Number:3540616 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. L'S 023361 90011508900 6 09 09 0 0000 0 000 1048204