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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDArYYY) 04/28/2022 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 be endorsed. If SUBROGATIONIS 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 CONTACT NAME: AUTOMATIC DATA PROCESSING INS AGCY PHONE (800)524-7024 (AIC, No, Ext): FAX (800)524-4013 (AIC, Nc): 76250937 1 ADP BLVD MIS 625 ROSELAND NJ 07068 E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURERS: 360CIVIC A CORP INSURER C 1845 W ORANGEWOOD AVE STE 255 INSURERO: ORANGE CA 92868-2051 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDLE IN R SUBR wvD POLICY NUMBER POLICY EFF M D POLICY EX P M D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE El OCCUR DAMAGE TO RENTED PREMISES Eaoccurrence) MED EXP (Any one person) PERSONAL BADV INJURY GEN'L AGGREGATE UM IT APPLIES PER GENERALAGGREGATE POLICY PRO- LOG JECT PRODUCTS -COMP/OPAGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me oxidant) ANY AUTO BODILY INJURY (Per person) ALL DWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB H CLAMS_ MADE GREGATE AGDE I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PER isTATUTE OTH- E.L EACH ACCIDENT $1,000,000 ANY YIN A PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA X 76 WEG AS2BYC 04/19/2022 04/19/2023 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) Nyes, describe under E.L DISEASE. POLICY LIME $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC000313, attached to this policy. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. Re: State job is performed in: CA City oT Jana Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Division BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ FL 4 IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-4058 AUTHORIZED REPRESENTATIVE. ACORD 25 (2016/03) �.J (lAt/7 CRO/Q/21 J Rbk Mmrrnmt WYm ©1988-2015 ACORD CORP - Renev�Fn6�AtrrxwmBr The ACORD name and logo are registered marks of ACORD 11t �' %u pittaee �R¢k Maeugenmr OarralAiee -,