2022/07/01 ADP TotalSource DE IV, Inc. (3)01117/2027
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. ANO THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificale holdsr is an ADDITIONAL INSURED, the policy(ies) must have AODITIONAL INSLTRED provisions or be endors€d. lf
SUBROGATION lS WAIVED, subject to the torms and conditions of the policy, certain policies may require an endorsement. A slatement on this
ce(ificate does nol confer rights to the certificale holder in lieu ot such endorsem€nt(s).
800 743,8130
ADPTolalSo!rceadmarsh com
!N SURER(S) AF F ORO[.IG COVERAGE
INSURER A: AIU lnsuranc. Comp.ny
PRODUCER
a drvision of Ma6h USA lnc
PO Box 14404
Des Mo n6g lA 50309-9586
INSURED
ADP T6t.ls6!rc6 DE l/ lnc
5800 Whdwad Parkway
l-llndeniler d. Llamas & Assmiate!
120 s slars colloo€ Blvd
,^La);
CERTIFICATE NUMBERCOVERAGES
WORKERS COMPENSATIOI{
A\ ''hJT]IETC:: AR'iN€F EXECL]I!!
OIFICTI{iME[IAER EXCLL]DEDi
OESCRIPT ON OF OPERAT ONS below
CERTIFICATE HOLDER
REVISION NUMBER
IHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE EEEN ISSUED TO IHE INSURED NAMEO ABOVE FOR THE POIICY PERIOO
INOICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITII RESPECT TO WBICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, IHE INSURANCE AFFORDED BY THE POLICIES OESCRIAEO HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAIO CLAIMS,
COMMERCIAL CENERAL LIABILITY
6EN LAGGREGATE LIT/ITAPPL ES PER
OI}]ER
JECT LOC
l
PREMISES 1Ea occ!nen.c)S
MEO eXP (Any one percon)$
PLfISONAL & ADV ]NJURY s
GENERAL AGGREGATE s
;
S
AUTOMOBILE LIAAILITY
OWNEOAUTOS ONLY
HIRED
SCHEDULEO
NON OWNED
COMBINEO SINGLE LIMIT S
BO0ILY !NJURY (Per person)5
BODILY iNJURY (Per a.cLdenl)s
S
I
S
S
RETENT]ON $I
T
a7 01t2a22
EL OISEASE - EAET1PLOYEE
L D SEASE - POLICY LIII T
s 2 000 000
s 2 000 000
DESCRIPIIOIi OF OPERATloI'IS / LOCATTONS / VEHICLES (ACORD l0l, AddlbnalRem.rk. Schodul., m.y b..tt.ch.d if mo@.p.c.1. r.qurnd)
All worksrle 6mploy.es workrng lor HINDERL|TER OE LLAMAS a ASSOCIATES. paid under ADP TOTALSOU RCE INC s payroll are covered und€. lha abovs slaled polrcy
WAIVERoFSUBROGATTONlNFAVOROFCrlyolMo.rrseASRESPECTSOFJOBPERFORIiEoBYHnde,lerdeLlamas&Asso.Eles aS REOUIREO BYWRITIEN CONTRACT
s 2 a!0 alrc
CANCELLATION
AUTHORIZEO REPRESENTATIVE
t)" lQ" z,.a-
@1988-20I5ACORDCORPORAT|ON. All rights reservGd.
The ACORD name and logo a16 registered marks ofACORD
SNOULD ANY OF THE ABOVE OESCRIBEO POLICIES AE CANCELLEO BEFORE
THE EXPIRATION OATE THEREOF, NOTICE IAIILL AE OELIVEREO iN
ACCOROANCE WITH THE POLICY PROVISIONS.
City of Menifee
29714 Haun Road
Menifee CA 92586
ACORD 2s (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
19399
!occun
07141/2023
I
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the 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 07 101 12022 1 2:01 AM forms a part of Policy No. WC 053422880 CA
lssued to
ADP Totalsource DE lV, lnc.
5800 Windward Parkway
Alpharetta, GA 30005
LtctF .
Hinderliter de Llamas & Associates
120 S State College Blvd
Suite 200
Brea, CA 9282'10000
By AIU lnsurance Company
We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against any person or organization with whom you have a written contract that requires you to obtain this
agreement from us. as regards any work you perform for such person or organization.
The additional premium for this endorsement shall be 2% of the total estimated workers compensation premium for this
policy.
ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF
RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE
OCCURRENCE OF LOSS
4*,1+dl-wc 04 03 61
(Ed. 11/90)
Countersigned by
Authorized Representative