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1551 N. Tustin Avenue Suite 450 <br />Santa Ana, CA 92705 <br />Phone: 714-689-0101 <br />CONFIRMATION OF COVERAGE BOUND <br />(BINDER CONFIRMATION) <br />Richard Campoli Jun 21, 2022 <br />Elmco Insurance Inc. <br />1905 N Main Street <br />Santa Ana, CA 92706 <br />Re: California Barricade Rentals, Inc. <br />Policy #:TXS0001452-03 <br />Effective: 7/1/2022 to 7/1/2023 <br />A -. 1. <br />We are pleased to confirm the attached binder for (Excess) being offered with Trisura Specialty Insurance <br />Company. This carrier is Non -Admitted in the state of CA. Please note that this binder is based on the <br />coverage, terms and conditions as stated in the attached binder, which may be different from those requested <br />in your original submission. As you are the representative of the Insured, it is incumbent upon you to review <br />the terms of this binder carefully with your Insured, and reconcile any differences from the terms requested in <br />the original submission. CRC Insurance Services, Inc. disclaims any responsibility for your failure to reconcile <br />with the Insured any differences between the terms bound as per the attached and those terms originally <br />requested. This coverage may not be bound without a fully executed CRC brokerage agreement. <br />NOTE: If insured is located outside your resident state, you must hold appropriate non-resident <br />license prior to binding. <br />Mailing Address: 1550 East Saint Gertrude Place <br />Santa Ana, CA 92705 <br />Physical Address: 1550 East Saint Gertrude Place, <br />Santa Ana, CA 92705 <br />Coverage as bound per the attached. Premium and Commission are as follows: <br />Premium: <br />$25,500.00 <br />TRIA Premium: <br />-REJECTED <br />Broker Fee <br />$700.00 <br />Company Policy Fee <br />$250.00 <br />Surplus Lines Tax <br />$772.50 <br />Stamping Office Fee <br />$64.38 <br />Total: $27,286.88 <br />Broker Fees & Policy Fees are Fully Earned at Binding <br />Commission: 10% <br />RAMwiagemadDiMsian <br />E <br />REVIEWED & APPROVED BY. <br />e Aeevaa <br />'�--'Risk Management Specialist <br />