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2022/02/01 Barrett Business Services, Inc.12t23t2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOTI OI.ILY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES T.IOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEE}{ THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND T}IE CERTIFICATE HOLOER IMPORTANT: lf the cartiflcato holder i3 an ADDITIONAL INSUREO, tho poliGy( the lerms and condltlons of tho pollcy, certain pollcles may rsqulre an endorsom6nt. A stat€mont on thls cettitlcato doos not confor rlghts to the t bo endorsod. lI SUBROGATION lS WAIVED, subject tolos) mus certificato holdor in lieu of such ondors6me 844-290,4908 22667 BBSlcerts@locktonafi inily com AFFORDING COVERAGE |NSURER A . Acs American lnsuranc€ Co Lockton Companies 444 W471h Street, Suite 900 Kansas City, L4O 64112-1906 Barrott Bu.lnoss Sorvicos. lnc. UC/F HEARTLANO GRADING 3142 IIGER RUN COURT STE 114 cARLSBAO, CA 92010 o.Ro"CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: CERTIFICATE HOLDER CANCELLATION REVISION NUMBER CITY OF MENIFEE 29714 Haun Road Ivlenafee, CA 92586 /1 , ,,y"{a a ,b-e O 1988-2014 ACORO CORPORATION. All rights reserved THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO EELOW HAVE BEEN INDICATED, NOTWTHSTANOING ANY REQUIREMENT, TERM OR CONOITION OF ANY CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY T ISSUED TO THE INSURED NAIT4ED ABOVE FOR THE POLICY PERIOD CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERITIS EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. LIMITS SHOV1.N IVAY HAVE BEEN REOUCED BY PAID CLAIMS EACI,I OCCL]RFENCE MED EXP PERSONAL & AOV INJURY GENERAL AG6REGATE PROOIJCTS. COMP/OP AGG COMM€RCIAL GENEIiAL LIAEILITY GEN'LA6GREGATE LIMIT APPLIES PER OCCUR OTI]ER L ]JECT L ] COMB NEO BODILY INJURY (P.rp€Bon) aOO LY TNJURY (P6.a@id6nt) s s AUTOS H REOAUTOS SCHEDULEO AUTOS NON,OWNED AUTOMOB LE LASL TY EACH OCCl]RRENCE s AGGREGA]EEXCESS L|AA occlJR NTT S 2 000,000 $ 2 000 000E L OISEASE. EA EMPL E L DISEASE ' POL CY LIM]I STA] L]] F i 2,000000 2t1t2422 2t1t?423 WOR(ERS CO{\IPENSAIION NE EMPr O /atrs LAalLii'Y ANY PROPRIETOR/PARTNEF]EXECI]TIVE OFF]CER/II,iEMBER EXCLLJOEO? RIPT ON OF OPERATIONSD OESCRTPION OF OPERATIONS / LOcAnOrt S / V€H TCLES {ACORD 1ol, Addition.l R.mlrlc sch6dur., m.y b. rtt..h.d lr moo .p.c. l. dqul6d) Blenkd waNsr or subocalro. in tavo. ol clnnreil holder whon 6qu@d by wnnen @nlact RE All Op€ral'on3 30 d.y mt@ ol en@lltl'on wil b€ prosdod ,hon possrbl€ SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CAiICELIED BEFORE THE EIPIRATION OATE THEREOF, NOTICE WILL BE OEUVEREOIN ACCORDANCE WITH THE POLICY PROVISIONS, ACORD 25 (2014/0't )The ACORD name and logo are registered marks ot ACORD s s 3 c699936?A Workers' compensation and Employers' Liability Policy Number: C6999362A Policy Number Symbol: Named lnsured Barrett Business Services, lnc. UC|F HEARTLAND GRADING 3,142 TIGER RUN COURT STE 114 CARLSBAD, CA 92010 Eflective Dale ot Endorsemenl 2t1t20222t112022 rO 2t1t2023 Policy Period lssued By (Name oflhe lnsurance Company) Ace American lnsurance Co. number The remainder ol lhe informatron ts lo be com leted only when thrs endorsemenl is issued su paralion of theenl lo thelnsen the ti CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement appties only to the insurance provided by the policy because California is shown in ltem 3.A. of the lnformation Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce oui right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneratlon of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization (x) Blanket Waiver Any person or organization for whom the Named lnsured has agreed by written contract to fumish this waiver. 2. Operations 3. Premium The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: INCLUDED ilal,rt* Authorized Agent wc 99 03 22 Endorsement Number