PACIFIC TRAFFIC CONTROL (PACIFIC HOLDCO SERVICES, LLC)

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ACO CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDIYYYY) 05l0672025 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 provislons 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 endorsement(s). PRODUCER NAME: Marsh Affinity Marsh Affinity C Nc Ext: 800.743.8130 FAX No): a dMslon of Marsh USA LLC. E-MAIL ADPToIalSourceC�marsh,cam PO BOX 14404 ADDRESS: Des Moines,IA 50306-9686 INSURERS AFFORDING COVERAGE NAIC# INSURER A: AIU Insurance Company19399 INSURED INSURER B: ADP TotalSource DE IV,Inc. INSURERC: 5800 Windward Parkway INSURERO: Alpharetta,GA 30005 UOR INSURER E: Pacific Services Holdco,LLC. INSURER I[ 2040 Lugo St. Los Angeles,CA 90023 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 TYPEOFINSURANCE ADDLSUBR POLICY NUMBER PO ICYEFP POLICYEXP LIMITS LTR INSD WVD (MMIDD1YYYY) (MMIDD1YYYY) COMMERCIAL GENERAL LIABILITY EACH 00 URRENCE $ CLAIMS-MADE OCCUR DAMAGETORENTED r,.e $ PREMISES Ea 000% MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT El LOC PRODUCTS-COMPIOPAGO S OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Par porsor) $ OWNED SCHEDULED BODILY Peraccldent $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY nt AUTOS ONLY Per accide UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESSLIAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PERO - AND EM PLOYERS'LIABILITY YIN X STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE � E.L.EACH ACCIDENT $ 2,000,000 OFFICER4NEMBER EXCLUDED? i '" i NIA X WC 069365914 CA 07/0112024 07/GN2025 A (Mandatory]n NH] E.L.DISEASE-EA EMPLOYEE $ 2,000,000 it yas,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) All workslte employees working for Pacific Services Holdco,LLC,paid under Anp TOTALSOURCE,INC.'s payroll,are covered under the above slated ppolicy,ProprialoriPartner7Exeeulive Ofricervemher are not excluded as longg as they are in the ADPTS pa roll or have completed the SEI Partlelpation Addendum.WAIVE F2 OF SUBROGATION IN FAVyOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY Pacific Services Holdco,LLC,AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Parks,Recreation,and Community Service SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic 20 Civic Center Plaz THE EXPIRATION DATE THEREOF, NOTICE: WILL BE DELIVERED 1N Santa Ana,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORGCORPO�PffION..All rights reserved. The ACORI7 name and logo are registered marks of AGORI7