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PROOF OF INSURANCE (2023) CLOSEDUYC AC"CERTIFICATE OF LIABILITY INSURANCE DATt(M E09/21//2022 M) 022 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. 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 endorsements . PRODUCER AON RISK SERVICES SOUTH INC 3550 X ROAD SUITE1AOGA30326NORTHEAST SUITE ATLANTA G CONTACT Aon Risk Services, Inc of Florida Florida HAd'I. gTry: trinet.COm FA ADDRESS, [ i Yurork.06o 1.. 'kI4 SAC o'"... INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED TnNet Group, Inc LIC/F Califa Group INSURER B C INSURER C : 1 Park Place, Suite 600 INSURER D Dublin, CA 94568-7983 INSURER E t INSURER F COVERAGES CERTIFICATE NUMBER: 15591282 REVISION NUMBER: 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, INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE ❑ OCCUR PREMISES Ea occurrence) MEDEXP An.y oneperson) PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT El LOC PRODUCTS - COMP/OP AGG $ $ OTHER COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) c $ BODILY INJURY Per person) $ ANY AUTO BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE �,...... HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident. $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEC I RETENTION $ WORKERS COMPENSATION LIABILITY ANYNN ERH E L EACH ACCIDENT $ 2.000.000 A EXCLUDED? PROIETOPARTNERIEXECUTIVE OFYCER PR N / A WLR,_.C71294298 07/01/2022 07I01I2023 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.. L.. DISEASE - POLICY LIMIT $ 2,000,000. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation coverage is limited to worksite employees of Califa Group through a co -employment agreement with TriNet HR III, Inc.. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE afon, Ccsk C-yetvfce6 &outlk Qnc C 1588-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD 09/21/2022 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). PRODUCER CONTA NAME Mercer Consumer, a service of PHONE FA'X Mercer Health & Benefits Administration LLC V No Ems1°877-451-4003 WC,Na): 155 N , Wacker Drive, 14 th Floor �.....'......_:.,.1,.,..,,,.....................................................�.,_,,,..,.,.............G...................... ..........��.,.,.,.. Chicago, IL 60606 Ark NAIC# ...INSURER........,lNSnaERasAFaFORDINI...a...............................................----n.n.---.. R Casualty . ROVERAGe Co 10.510 INSURED CALIFA GROUP 330 TOWSEND STREET, SUITE #133 SAN FRANCI SCO, CA 94107 F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, INSF . ..._........................... 15 1599.,.,_.... P L ELF XP 6�M00var TYPE OF INSURANCE LTR i � POLICY NUMBER i LIMITS yY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ — I� DAMAG CLAIMS -MADE OCCUR PR EMISES MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO - ... POLICY JECT LOC PRODUCTS C0MPI0PAGG $ $ --` O'I'HER�: AUTOMOBILE UTOMOBILELIABILITY COMBINED SINGLE LIMIT EP uc 40n --- - $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS .. -OWNED ROP $ HIRED AUTOS AUTOS _m ..•. ERw p))DAMAGE: ........ �... .... ...._ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE . .DED�. �. AGGREGATE $ RETENTION $ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS' LIABILITY Y J N STI)T,I1T ANY ECUTIVE OFFICE(MandaIMEMBE EXCLUDED? JN/A I in NH) E.L.DSEASE EA EMPLOYEE..$ If Dory yes, describe Y rPOLICY TAON under F OPERATIONS below E L. DISEASE-.................... ....... ..� .,--....... LIMIT I $ A DCP-1862399 P3 08 /, n,/,'20 :` $1,000,0U0 per c1. $5,000 RETENTION DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L:tK I It-IL:A I t 11LJLUtK City of lit Segundo 350 Main ,Street El Segundo, CA 902.4.5 -3813 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CousineaU, DlIRinlVyuwg AP dby Couslneau, S.Ily A DN' rn,,,,Imomneau, Sally A. 88 AGOf DOOFtPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD DS#131176304