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ACC) t® CERTIFICATE OF LIABILITY INSURANCE DATE/(MM ON Y) 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 endorsement(s). PRODUCER M3 Insurance Solutions, Inc. 828 John Nolen Drive CONTACT NAME: PW1, No RONE . 800-272-2443 FAX Ras, info m3ins.com A L. Madison Madison 1NI 53713 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Charter Oak Fire Insurance Com 25615 INSURED TOTAADM-01 Basic Benefits, LLC /Basic Payroll, LLC INSURERS: The Travelers Indemnity Com an 25658 INSURER C: Travelers Property Casualty of 25674 INSURER D: The Travelers Indemnity Co. of 25682 INSURER E: Liberty Surplus Insurance Co. 10725 INSURER F: ACE American Insurance Company COVERAGES CERTIFICATE NUMBER: 1678380501 RFVISION NIIMRFR- 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 ADDLSUBR INSD MID POLICYNUMBER POUCYEFF IMMIDONYYYI POLICY EXP IMMIDDIYYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR H6305ABB8588COF19 10/1/2019 10/1/2020 EACHOCCURRENCE $1,000,000 DAMAGE TORENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERALAGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BA6NI85851 10/1/2019 10/1/2020 COMBINED tSINGLE LIMIT g1,000,000 BODILY INJURY Doman) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per ( ) $ HIRED NON_OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Perecddent $ C X UMBRELLA LIAR X OCCUR CUP6J097403 10/l/2019 10P1/2020 EACH OCCURRENCE $10.000,000 AGGREGATE $10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDEDI NIA UB6J691951 10/1/2019 10/1/2020 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, scribe antler E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below E F Professional Liability Cyber Liability E05NAAI1 R0006 D9487791 10/1/2019 10/1/2019 10/1/2020 10/1/2020 Aggregate Aggregate 2,000,000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Verification of Insurance only. Verification of Insurance only. City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE 1 I c.pev ©1988.2015 ACORD reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD