|
7&WRJ
<br />CERTIFICATE CIF LIABILITY INSURANCE � 4ATLIfYYYY1
<br />�- 1 22/1 11212z/zo1 a
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER, 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 certiflcate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or he endorsed,
<br />If SUBROGATION IS WAIVt=D, subject to the terms and condit4ons 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 CONTACT
<br />NAME: Risk Management Department
<br />Commercial Lines
<br /># .C#v.Eattl' 86&.443-8489 _. �. G Hale 800-889-g021
<br />U91 Insurance Sorvices National, Inc, ADDRE38: worlccomp@trinet.corri
<br />2601 South Ciayshore Drive, Suite 1fio0 ._.... .........._I... ...._....... __._........_............... ..........
<br />IN&UR5RIl AFFORDING C(}VER_AG_E NAIC it
<br />Coconut Grove, FL 33133 INSURERA: ACE American Insurance Companv _ -- 22667
<br />INSURED - INSURER a:
<br />TriNet HR III, Inc. ---"��"-""""��'°""�'"•""•"" —�----�""'"µ
<br />INSURER 0:
<br />L/C/F Sedaru, Inc. FKA ID Modeling, Inc, INsugFRn;-
<br />9000 Town Center Parkway UJSURER a :
<br />Bradenton, FL 34202 INSURER F: j
<br />COVERAG15S CERTIFICAT5 NUM13FRI 13717410 ul I"RPR. CAa hPln,
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN issurr) TO THC INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMaNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED CR 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 />ILFR�`- TYPF OF INSURANCE iADpI..i5U9R �` poiICYNUMBtR mmmm —
<br />NFM1pOG31YYYY
<br />MrOfiIDpIYYYY
<br />LIMITS --
<br />OOMMERCIAL GENERAL LIABILITY
<br />! F CLAIMS -MADE ��., OCCUR I !
<br />i.__._.�_.._....
<br />EACHOCCURRENCE $
<br />Af11'1�C3�'7tl'"fasNYto............................._.........................-,._ ..._.
<br />pREMICEB (Ea occurrence
<br />rv1En FiSP IA11 PP_E Pef50f1)
<br />_._..I_....M»..»»»,«„»„».».,.,».»»..»............ I {�
<br />PERSONAL & ArW INJURY
<br />! ! J]
<br />GENT AGIORFOATE LIMIT APPLIES PER:
<br />€{[
<br />�..� POLICY JECI• LOC
<br />OTHER:
<br />—
<br />GEN"RAIAGGREGATE s
<br />PRODUCTS - COMPYOPAGGPR
<br />AUTOMOBILE LIABILITY !
<br />II�—. �
<br />C dIBIN .D SINCyLE LIMllT I5
<br />Ea acaden! I
<br />ANY AUT6
<br />44L,,.....
<br />BODILY INJURY (Per parson) $
<br />..., OWNED ;SCHEDULED
<br />AUTOS ONLY !AUTOS
<br />HIRED , NON -OWNED
<br />AUTOS ONLY ; AUTOS ONLY
<br />�
<br />BODILY iNJl1RY {Per acclrlelti} S
<br />PROPERTYDAMAGE S
<br />€
<br />Per acPldsnf
<br />i5
<br />I 1 I
<br />! UMORELLALIAR t
<br />OCCUR 1
<br />EXCESS LIAR I !
<br />CLAIMS -MADE° !
<br />M �
<br />EACH OCCURRENCE S
<br />AGGREGATE S
<br />S
<br />DED RETENTIONS �
<br />WORKERS COMPENSATION !
<br />A AND EMPLOYERS'LIABILITY YIN j WLR C65449134
<br />ANYPROPRIE'rONIPARTNERffEXEOUTIVE
<br />OFMCEWMIEMBEREXCLUDED7 F NIA'
<br />(Mandatory Qt NH)
<br />Ir as, describE under
<br />D�uCRIPTION OP CSPERATIONS haiOw I
<br />711120'10
<br />71112019
<br />R p N• [
<br />X STATUTE ER =
<br />E.l.. EACH ACC1DENi is 2,000,tl00
<br />_....»...,.
<br />EL. DISEASE - EA EMPLOYEEI S 2,000,000
<br />E.L. D151*ASE- POLICY LIMIT j 5 2,BOtl,tlOP
<br />I
<br />i I
<br />!
<br />[fj
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD I ' ' s ? , c or space is required)
<br />Workers Compensation is limited to worksite employee a r I�rltleInrrs a co -employment contract with TriNot HR ill, Inc.
<br />PAGE OF
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Ross Annex (M-22
<br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
<br />(/�j
<br />The ACORD name and logo are rogisterod marks of ACORD Q 19OU-2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 2512016103) - .,........ ............ ....... ...... .........
<br />City Council 20 — 36 11/21/2023
<br />
|