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Last modified
4/15/2021 11:25:00 AM
Creation date
9/25/2020 3:16:10 PM
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Template:
Contracts
Company Name
HELPMATES STAFFING SERVICES
Contract #
A-2020-185
Agency
Human Resources
Council Approval Date
9/15/2020
Expiration Date
6/30/2021
Insurance Exp Date
8/9/2021
Destruction Year
2026
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sgirally sign H by Francine R. <br />Francine R. Villareal vlllarsal <br />D.: 2020.09.160909:51 Ll'00' <br />" CERTIFICATE OF LIABILITY INSURANCE <br />A�/ <br />DATsIMNUDDIo <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Assurance, a Marsh & McLennan A LLC company <br />Agency y <br />20 N Martingale Road p y <br />Suite 100 <br />Schaumburg IL 60173 <br />CONTACT <br />NAME: Megan Glascott <br />PHONE 847 598-8745 ac No: 847 440-9126 <br />AIL <br />ADDRESS: m lascottassurances enc .com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Zurich American Insurance Co <br />16535 <br />INSURED TRUSTEM-01 <br />Trust Temporary Services, Inc. dba Helpmates Staff <br />1200 Main Street <br />INSURER B: American Guarantee & Liability <br />26247 <br />INSURER C: Columbia Casualty Cc <br />31127 <br />INSURER D: Benchmark Insurance Company <br />41394 <br />Suite A <br />Irvine CA 92614 <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 717828874 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICYINUMBI <br />POLICY SEE <br />WMADDIYYYO <br />POLICY EXP <br />IMMIDDITY'r)')LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE I OCCUR <br />PRA9698655D8 <br />4/1/2020 <br />4/1/2021 <br />EACH OCCURRENCE <br />$1.000,000 <br />OAMA ETORENTED <br />PREMISES iEa acwrrenca <br />8100,000 <br />MED EXP (Any one person) <br />$10.000 <br />PERSONAL B ADV INJURY <br />$1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY j COT F7 LOG <br />GENERALAGGREGATE <br />$2.000,000 <br />GEN'L <br />X <br />PRODUCTS - COMP/OP AGG <br />$2,000,000 <br />$ <br />OTHER: <br />B <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />BAPS91335306 <br />PRA969865508 <br />4/1/2020 <br />4/1/2020 <br />4/1/2021 <br />4/1/2021 <br />COMBINED SINGLE LIMIT (Ea accident) <br />g1,000,000 <br />BODILY INJURY (Per Persan) <br />$ <br />X <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY amdedd Per <br />( ) <br />$ <br />X <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Paraccident <br />$ <br />$ <br />B <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />UMB946720208 <br />4/1/2020 <br />4/1/2021 <br />EACH OCCURRENCE <br />$5,000,000 <br />AGGREGATE <br />$5,000,000 <br />EXCESSXUAB <br />CLAIMS -MADE <br />OED X RETENTION$ n <br />$ <br />D <br />WORKERS COMPENSATION <br />ANDEMPLOYERS' LIABILITY YIN <br />WCBITS000014400 <br />8/9/2020 <br />8/9/2021 <br />X I PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />ANYPROPRIETOR/PARTNEWEXECUTIVE <br />OFFICERIMEMBEREXCLUDED4 <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000.000 <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$1,000.000 <br />DESCRIPTION OF OPERATONS below <br />A <br />A <br />O <br />Crime(3rd Party) <br />Professional Liability(Per sec.) <br />Cyber Liability <br />PRA969865508 <br />PRA969865508 <br />596881085 <br />4/1/2020 <br />4/1/2D20 <br />4/1/2020 <br />4/1/2021 <br />4/1/2021 <br />4/11202, <br />3,0D0,000 Limit <br />$2MMocc./$4Magg <br />Agg:$1•000,000 <br />5,000 Ded. <br />25,000 Ded. <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, maybe attached if more space is required) <br />Proof of Insurance <br />It is agreed that the following are added as Additional Insureds, when required by written contract, on the General Liability on a primary and non-contributory <br />basis with respect to operations performed by the Named Insured in connection with this project: THE CITY OF SANTA ANA, IT'S OFFICERS , EMPLOYEES, <br />AGENTS, AND REPRESENTATIVE <br />A Blanket 30 Day Notice of Cancellation applies to the General Liability and Hired and Non -Owned Automobile Policies. <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />• as,PP. RWrMoMgawdDheelon <br />tl '& REY4EWEo ✓t APPROV®BY: <br />` Risk Managrui Analyst <br />
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