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2021/08/18 DaySmart Holdings, LLC
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDLSUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed. IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementon this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD DAYSM-2 OP ID: PR 11/29/2021 Carolyn Kinsler Korotkin Insurance Group P O Box 431 Southfield, MI 48037-0431 JJ Reifler 248-350-5818 248-352-0305 carolynk@getkig.com Citizens Ins Co. Of America Allmerica Financial Benefit DaySmart Holdings, LLCDaySmart Software, LLCSEE NOTES SECTION3520 Green Court Suite 250Ann Arbor, MI 48105 Hanover Ins. Co. Scottsdale Ins. Co. Admiral Ins. Co. A X 2,000,000 X X Z7B-D700443-00 09/16/202109/16/2022 100,000 10,000 2,000,000 4,000,000 X 4,000,000 1,000,000A X Z7B-D700443-00 09/16/202109/16/2022 X X XX 5,000,000A X U7B-D700484-00 09/16/202109/16/2022 5,000,000 0X XB W2B-D700411-00 09/16/202109/16/2022 500,000 500,000 500,000 C BDD-D697376 09/16/202111/15/2021Crime 1,000,000 Certificate holder, its officers agents & employees shall be additional insured on policies so checked when required by written contract or agreement. MENIF-1 City of Menifee Office of Finance 29844 Haun Road Menifee, CA 92586 248-350-5818 31534 10212 22292 Crime DocuSign Envelope ID: 52CC7DEA-DB86-401E-B67E-EC367616105F NOTEPAD PAGE INSURED'S NAME Date 2 OP ID: PR D - Excess Cyber Liability: 11-15-21 to 09-16-2022, Policy #EKS3406585, Carrier: Scottsdale Ins. Co., Limit: $2,000,000 E - Primary Cyber Liability: 11-15-21 to 09-16-2022, Policy #EO000055670 -01, Carrier: Admiral Ins. Co., Limit: $3,000,000 Named insured schedule: Daysmart Holdings LLC Daysmart Software, LLC Oak Intermediary II, LLC Oak Intermediary, LLC Oak Purchaser, Inc. (no Workers Compensation) DaySmart Blocker, Inc. StormSource, LLC dba Appointment Plus Vetter Software Inc. Dash Platform, LLC DAYSM-2 11/29/2021DaySmart Holdings, LLC DocuSign Envelope ID: 52CC7DEA-DB86-401E-B67E-EC367616105F