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CERTIFICATE OF LIABILITY COVERAGE <br />DATEINMAXrnr Y) <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 LIABILITY COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: R the certificate holder is Be ADDITIONAL t;uVERE0 the policy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to <br />PRODUCER <br />CONTACT <br />Union -Employer Joint Plan Sponsors <br />"ME: <br />Compass Pilot <br />Omega Community Labor Association <br />330 Bullard Avenue <br />PxONE <br />FAX <br />Clovis, CA93612 <br />Na.E-1) <br />(833)4274568 (AQIii (BDO)673-0183 <br />Info@compasxpiiolwc.com <br />ISWERIS) AFFOMM COVERAGE <br />COVERED <br />✓ <br />ImveftA:_ <br />- <br />COMPASSPILOT <br />Santa Ana Security Services, Inc <br />ERISA-based member benefit program of <br />1717 S. Main St. <br />OMEGA COMMUNITY LABOR ASSOCIATION <br />Santa Ana, CA 92708 <br />lase s , <br />ISSUERC, <br />NI IMnco <br />THIS IS TO CERTIFY THAT THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE COVERED NAMED ABOVE FOR THE POLICY <br />PERIOD INDICATED. NOTWITHSTANDING ANY REWIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO <br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE POLICIES DESCHIOEO HEREIN 18 SUBJECT 10 ALL <br />THE TERMS. EXCLUSIONS AND CONDITIONSOF SUCH POLICIES. LIMITS SHOWN MAYHAVEBEEN REDUCED Sy PAID CLAIMS <br />LTA TVPEOFCOVERAOE ADDL aUeR - - POLICYEPT POLICY EAP __.__ <br />COV4 WVD POGCYNUNBER aALLD0.'1'YTm INWDO'YYWI lllefa <br />CONNERCMLGEIIERALUABRITT FACHOCCUIWNCE S <br />CtAm MAOE OCCII. DAMAGETORENTED - <br />PREANRES(Fsaca .) f <br />MED EAP IAnr one MrLrnl f <br />PERSONAL A ADV Ri IUNY $ <br />GFN'LAGGREGAIELeNTPER GENERAL AGCJ!€GATE S <br />POLICY PRO LOC PRODUCTS - COMPRW AOG S <br />.ACT <br />3 <br />AVTOYO9ILE UAe1UTY <br />(C. Pell f <br />ANYAUTO SODILYDAAHm Ilwpe ) S <br />ALL OwNEO - SCHEDULED <br />ALTOS AUTOS BODILYINAIRY(PNamaron) 5 <br />WREOAUI05 NO!" OWNED PROPERTY OHMAGE S <br />s <br />UARI ELLAUAB OCCUR EACH OCCURRENCE 5 <br />nclissuAll CLAIII&MAOE AGGREGATE S <br />DED RETEx11 N o F <br />A -WORKERS COMPENSATION EP-CA-2020-01 41272020 4Ct6+2021 ! SPTATUfE <br />ANDEVIKOVERS• uAaelrY J/ <br />E.L. EACHACCJCENT s 1.000,000 <br />ANY PROPRIETOMPARTNERAWCUTTA -' - <br />OFgCE;nQM ER EXCLUDED (YIN) E.L. DISEASE EA OIPLOYEE S 1.000,000 <br />E.LDISEASE POUCYLRaT S Low7 ow <br />DESCRPiIONOF OPERATIONSILOCATpNSIVENCLES: HEVIEWED OI ftrr �f> <br />Omega Community Labor Association Offers employer Inbdi(m .9 I�gq-s a e e - rage limits as an adsa-protected member benefit <br />program (Compass Pilot). AB lialoddy proteclWn and member— e l pO I'M As' 1N� FWk€iAle bargaining agreement only. U S. Dept of labor <br />Form M-1 Multiple employer welfare arrangement filing codeECE. '' 11``'' <br />Workers' compensation coYerage benefit provided solely for the Na�6tlE r d �8,h the agreement between Elemental PEO and Ortega <br />Community Labor Association. <br />CERTIFICATE HOLDER ..IYylt NCEIll I ennN <br />r <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Covered Copy ACCORDANCE WITH THE POLICYPROVISIONS. <br />AUTNORU'EG RFPRESENTAnVE <br />RiskMsrugonmtD[wian <br />�q a rREVIEWED&pAPPRO/V/EDBY�: <br />i �,1®aal.uee.-i-` r�F1Y.N.[ M1, V�AN1tRi <br />Risk Management Analyst <br />