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2021/07/01 ADP TotalSource CO XXI, Inc. Certificate Number 3508347YYJ �� 06/09/2021 `lllt Q_ �� CERTIFICATE OF LIABILITY INSURANCE DATEI09/20Y1 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 AOn Risk Services. Inc Of Florida NAME: PHONE FAX AfC No Ex! ; 800-743-8130 q/C Ha ; 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 EMAIL ADDRESS: ADP.COI.Center Aon.corn INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AIU Insurance Company 19399 INSURED ADP TotalSource CO XXI, Inc INSURER B INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D : L/C/F ADVANCED HEALTHSTYLES FITNESS EQUIPMENT INC DBA Advanced Exercise Equipment, Inc 86 F Southpark Dr 100, INSURER E : INSURER F Littleton, CO 80120 COVERAGES CERTIFICATE NUMBER: 3508347 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. ILT R R, LT TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/VYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER AUTOMOBILE LIABILITY COMBINED St GLE LIMIT Ea accident $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Par accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEC I I RETENTION $ _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X STER ATUTE ORN E.L EACH ACCIDENT $ 2,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A X WC 038368195 CA 07I01/2021 07/01/2022 E L DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory in NH) If yes, describe under E.L DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for ADVANCED HEALTHSTYLES FITNESS EQUIPMENT INC. DBA ADVANCED EXERCISE EQUIPMENT, INC., 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 ADVANCED HEALTHSTYLES FITNESS EQUIPMENT INC. DBA ADVANCED EXERCISE EQUIPMENT, INC. AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION City of Menifee I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:FinanceDepartment- AccountsPayable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29844 Haun Road Menifee, CA 92586 ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE Ifl &Ion Ai6h 8etV&eA, 9110 o f (Floitr:t2 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1 018176 90011485800 5 04 02 0 0000 0 000 1001298 Certificate Number: 3508347 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 038368195 Issued to ADP TotalSource CO XXI, Inc. By: AIU Insurance Company 10200 Sunset Drive Miami, FL 33173 L/C/F ADVANCED HEALTHSTYLES FITNESS EQUIPMENT INC. DBA Advanced Exercise Equipment, Inc. 861 Southpark Dr 100 Littleton, CO 80120 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. Person or Organization City of Menifee Attn: Finance Department - Accounts Payable 29844 Haun Road Menifee, CA 92586 WC 04 03 06 (Ed. 4-84) Schedule Countersigned by Job Description Authorized Representative 018176 90011485800 5 04 03 0 0000 0 000 1001298 Certificate Number:3508347 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. . �?+ 018176 90011485800 5 04 04 0 0000 0 000 1001298