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Francine R.-olyltallysignEdby Frundne R.VllllamaI Villareal DUE: 2021.00.1716:3024-07'00' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/11/2021 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 Doug Jones (Justworks) do Artex Risk Solutions, Inc. P.O. Box 13838 CONTACT NAME: Justworks Customer Success PHONE FA% _(AL6.NP. EA (888) 534-1711 A/( C No): ADDRESS: support@justworks.com INSURERS AFFORDING COVERAGE NAIC M Scottsdale, AZ 85267 INSURER A: American Zurich Insurance ComDanV 40142 INSURED Justworks Employment Group _LC Labor Contractor, for co -employees of: Benevate, Inc. INSURER B : INSURER INSURER D PO Box 7119 Church Street Station New York, NY 10008-7119 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:21NY0171006023 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, INTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MMIDDIYYYYI POLICY EXP IMMIDDIYYYYTLIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ PREMISES TD RE TED S La occurrence $ MET EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY D PRO- ❑ ECT OC PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea scald ad $ BODILY INJURY (Par person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY FlUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN _ PER OTH- X STATUTE I ER E.L. EACH ACCIDENT $ 2000,000 A ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ NIA WC 49-71-166-02 06/01l2021 06/01l2022 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 (Mandatory In NH) f yes, describe under DESCRIPTIONOFOPERATIONSbelow E.L. DISEASE -POLICY LIMIT —- $ 2,000,000 Location Coverage Period: 06/01/2021 06/01/2022 Clientlf 25327-GA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is rer ul red) Coverage is provided for Benevate, Inc. only those co -employees 3423 Piedmont Road NE Suite 216 of, but not subcontractors Atlanta, GA 30305 ta: City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE dba: Community Development Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROV Santa Ana, CA 92701 'rRIti%v. PJAManagemanaDfvlelan AUTHORIZED REPRESENTATIVE yy x @ REVIEWED&APPRDVE7BY., Furl ry `/ ice' !✓ RNk ManagemzmAnalySt ©1988-2015 ACORD C .a?_ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD