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2021/04/01 Shaw HR Consulting, LLC01/12/2022 Tolman & Wiker Insurance Services, LLC 196 S. Fir Street PO Box 1388 Ventura CA 93002-1388 Alexandra Lovato-Robinson (805) 585-6114 (805) 585-6114 alovato-robinson@tolmanandwiker.com Shaw HR Consulting, Inc. 107 N. Reino Rd., #414 Newbury Park CA 91320 Ohio Security Ins Co 24082 American Fire & Cas Ins Co 24066 Employers Preferred Ins Co 10346 Admiral Ins Co 03026 21/22 GL/AU/UMB/WC/ PROF A Y BKS 22 56447520 04/01/2021 04/01/2022 1,000,000 500,000 15,000 1,000,000 2,000,000 2,000,000 A BAS 22 56447520 04/01/2021 04/01/2022 1,000,000 B 10,000 USA 22 56447520 04/01/2021 04/01/2022 1,000,000 1,000,000 C Y EIG132510910 04/07/2021 04/07/2022 1,000,000 1,000,000 1,000,000 D Errors & Omissions EO000051417-02 05/21/2021 05/21/2022 Limit:$2,000,000 Dec:$5,000 GL: City of Menifee and its officers, employees, agents, and authorized volunteers are Additional Insured as respects to operations of the Named Insured per form CG88100413. This Insurance is Primary & Non-Contributory to any other Insurance per form CG88100413. WC: A Waiver of Subrogation is added in favor of the Additional Insured per form WC040306. Endorsements apply only as required by current written contract on file. City of Menifee and its officers, its employees, agents, and authorized volunteers 29844 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1 DocuSign Envelope ID: 68F66696-9342-4840-89B1-05BCDCB2F2B1