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P3 ADAPTIVE (POWERPIVOTPRO, LLC)
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P3 ADAPTIVE (POWERPIVOTPRO, LLC)
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Last modified
5/20/2025 4:31:31 PM
Creation date
4/19/2024 9:25:12 AM
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Contracts
Company Name
P3 ADAPTIVE (POWERPIVOTPRO, LLC)
Contract #
N-2024-138
Agency
Public Works
Expiration Date
3/19/2025
Insurance Exp Date
7/1/2025
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P8R <br />A4C/7 O® <br />lyVil` CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />F 11/2712024 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be <br />endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A <br />statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . <br />PRODUCER <br />AON RISK SERVICES SOUTH INC <br />CONTACT A <br />NAME: on Risk Services, Inc of Florida <br />PHONE FAX <br />A/C, No, Ext : 833-506-1544 AIC, No): <br />3550LENOX ROAD NORTHEAST <br />SUITE 1700 <br />ATLANTA GA 30326 <br />EMAIL <br />ADDRESS: work-comp@trinet.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A : ACE American Insurance Company <br />22667 <br />INSURED <br />TriNet Group, Inc. L/C/F PowerPivotPro LLC <br />INSURER B : <br />INSURER C : <br />1 Park Place, Suite 600 <br />Dublin, CA 94568-7983 <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 15797340 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />AMAG <br />CLAIMS -MADE ❑ OCCUR <br />PREM SESOEa olccur ence <br />$ <br />MED EXP (Any one person <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY PROJECT LOC <br />PRODUCTS - COMP/OPAGG <br />$ <br />$ <br />OTHER <br />SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />Ea acINED cci,.r") <br />$ <br />ANY AUTO <br />BODILY INJURY Perperson) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />HIRED NON -OWNED <br />PROPERTY DAMAGE <br />AUTOS ONLY AUTOS ONLY <br />I <br />Per accident <br />$ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DEC I I RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ 2,000,000 <br />A <br />ANY PROPRIETOR/PARTNER/EXECUTIVE FT <br />OFFICER/MEMBER EXCLUDED? <br />N / A <br />X <br />WLR C57632124 <br />— <br />07/01/2024 <br />07/01/2025 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 2,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ 2,000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Workers Compensation coverage is limited to worksite employees of PowerPivotPro LLC through a co -employment agreement with TriNet HR III, Inc.. <br />Waiver of subrogation in favor of City of Santa Ana Public Works Agency - Water Resources Division as required by written contract. <br />A 30 day notice of cancellation is endorsed to the policy for the City of Santa Ana Public Works Agency - Water Resources Division. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana Public Works Agency - Water Resources Division <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza (M-30), PO BOX 1988 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92702 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />01"Fon ask cletvices &outl= 2nc <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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