2023/02/01 Barrett Business Services, Inc.12t29t2022
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT EETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER.
IMPORTAI'IT: lI tho csrllflcato holdor ls an ADDITIONAL lNSURED, tho pollcy(io!) mult havs AODITIONAL INSURED provislon! or bo ondoEed. lf
SUBROGATION lS WAIVEO, !ubisct to tho torms and condltlon! ol tho potlcy, certaln pollclos may .oquire .n endo.semenL A stalomont on thls
certificato do6s not contor rlghts to the cortlflcato holder ln lleu ot auch ondotsomenl(s).
PRODUCER
Lockton Companies
444 W 47th Street, Suite 900
Kansas City, MO 64112-1906 EBSlc6ns@locklonrfiini
INSURER(S ) AFFORDING COVERAGE
tNsuRERA, Ac€ Americ3n ln3uranc€ co 22667
INSUREOBa ett Bu.inc$ Sorvlco., lnc.
UC/F HEARILAND GRADING
3142 TIGER RUI{ COURT STE 114
caRlsBAO, CA 92010
iQo"CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBER:
CERTIFICATE HOLDER CANCELLATION
REVISION NUMBER:
1988-2015 ACORO CORPORATION. All rights roserved.
THIS IS TO CERTIFY THAI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED AEOVE FOR THE POLICY PERIOD
INOICATEO NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER OOCUMENT WTH RESPECT TO vvHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRISED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. LIMITS SHOWI! MAY HAVE BEEN REDUCEO BY PAIO CLAIMS.
LIMITS
COMMEiCIAL GENERAL LIABILITY
OCCUR
GEN L AGGREGAIE L]MII APPLIES PER
JECI LOC
EACHOCCURRENCE $
DAMAGE TORENTEO
PREM sES lEao@Eenc6l $
MEO ExP (Any on. peGon)s
PERSONAI IT ADV INJURY s
GENE RAL AGGREGATE ,
PROOUCTS , COMP/OP AGG I
s
AUTOMOBILE L]Ag LITY
ovlNEo
AUTOS ONLY
HIREO
AUIOS ONLY
SCHEOULEO
AUTOS
NON.OWNEOAUIOS ONLY
COMBLN€D SINGLE L MIT !
BOO LY INJURY (Porp6Bon)5
BOOILY INJURY (Per 3@idenl)$
$
$
EXCESS LIAB
occuR
c51299965
EACH OCCURRENCE s
AGGREGATE s
.]E D 3
WORKEiS COiIPENSATION
ANO EM PLOYERS' UABII-I]Y
ATIY PROPRIETOA/PAATNER,''J(ECUTIVEOFFICER/XIEMBER EXCLI]OED?
DESCRIPTION OF OPERAIIONS b6I@
x 2t112423 2t1t?424
x oTtl-
E L €ACH ACCIOENT I 2,000 00O
E L DISEASE. EE EMPLOYEE ,2000,000
E L DISEASE - POLICY LIMIT i 2,000,000
oEscRpnoN oF oPERAIIoNS / LocATtoNs , vEHlcLEs (acoRo 1ol, Addhlond R.m..tt sch.du.,n.y b..n.ch.d itho-.p...1. requicd)
Brrnksl wriv.r ol subrcgarion ln r3vo. ol @d @le hold€r wh6n 6q!r6d by wnlbn @nlracl
RE: Arr Opo6lio.3 30 day noti@ or c€ncgllsiion will bo pBvided wh6n po33 bl.
CIW OF MENIFEE
29714 Haun Road
Monlfee, CA 92586
SSOULD ANY OF TH€ ASOVE DESCRIBED POLICIES BE CANCELI.ED BEFORE
THE EXPIRAIOTT DAIE IXEREOf, NOTICE WILL BE OELIVEREOIN ACCORDANCE WIIH THE POUCY PROVISIONS.
AIJTHORIZED REPRESENTATIVE
/* ^ a""w
The ACORO name and logo are registsred marks of ACORO
844-290-4908
ACORD 25 (2016/03)
Workers' Compensation and Employe6' Liability Policy
Named lnsured
Barrett Business Services, lnc.
UC/F HEARTLAND GRADING
3142 TIGER RUN COURT STE 114
CARLSBAD, CA 920'10
Endorsement Number
Policy Number
Symboli VVLR Number: C51299966
211t2023 rO 211t2024
Efieciive Date of Endorsement
21112023
lssued By (Name of the lnsurance Company)
Ace American lnsurance Co.
lnsert lhe policy number. The remeind€rol Ihe inlormation is to be completed only when this €ndorsement is issued subsequenl to the preparation ol the policy
This endorsemenl chanoes the Dolic.r' lo which it is atlached and is ettective on lhe dale issued unless olheMise slaled.
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies 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 our right against the person or organization named in the Schedule, but this waiver applies
only with respect to bodily injury arising oul 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 remuneration 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:
ALL CALIFORNIA OPERATIONS
3. Premium:
The premium charge for this endorsement shall be 1.0 percent of the Califomia 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: $0 Qazqi;..<
Authorized Agent
wc 90 03 75 (05/18)
Policy Period