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A� Dr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOMlYY) OB/29/2021 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 Ada Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE AIC Na Ezt : 800-743-8130 AC, No): 800-522-7514 1001 Bnckell Bay Drive, Suite A1100 Miami, FL 331314937 EMAIL ADDRESS: ADP.COLCenter Aon.com INSURER(S) AFFORDING COVERAGE NMCM INSURER A: AN Insurance Company 19399 INSURED ADP TotalSource DE IV, Inc. INSURER B : INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D : UC;F Keyser Marston Associates, Inc. 1299 Fourth St. Ste 408 INSURER E El INSURER F : San Rafael, CA 94901 COVERAGES CERTIFICATE NUMBER: 3608603 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. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDO POUCYEXP MMIDD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea so...) c... $ MED EXP (My oneperson) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FIPROJECT LOG OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Petperson) $ BODILY INJURY Peraccident $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAR H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEIVEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yg, desvibe under DESCRIPTION OF OPERATIONS below NIA WC 038367524 CA 07/01/2021 07/01/2022 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2.000,000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See attached CerliOcate Holder Cancellation Notice. All worksite employees working for KEYSER MARSTON ASSOCIATES, INC., paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. CtK I IFIQA It HULUCK City of Santa Ana Risk Management Division 20 Civic Center Plan 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 PROVISKINc AUTHORIZED REPRESENTATIVE REY111pm4APPRLN®Br. Risk Managenel Claiul Nde 19as-2075 ACORD CC ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD