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FIFTH ASSEST, INC. dba DEBTBOOK
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FIFTH ASSEST, INC. dba DEBTBOOK
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Last modified
11/17/2025 11:32:50 AM
Creation date
7/3/2025 10:06:39 AM
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Contracts
Company Name
DEBTBOOK (FIFTH ASSEST, INC.)
Contract #
N-2025-156
Agency
Finance & Management Services
Expiration Date
5/14/2027
Insurance Exp Date
11/1/2026
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23Q3 <br /> A�L> DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 05/22/2025 <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 CONTACT A <br /> AON RISK SERVICES SOUTH INC NAME: on Risk Services,Inc of Florida <br /> 3550 LENOX ROAD NORTHEAST PHONE FAX <br /> SUITE 1700 A/C,No,Ext:833-506-1544 A/C,No): <br /> ATLANTA GA 30326 EMAIL <br /> ADDRESS: work-comp@trinet.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Indemnity Insurance Company of North America 43575 <br /> INSURED INSURER B: <br /> TriNet Group,Inc.L/C/F Fifth Asset,Inc DBA Debtbook <br /> 1 Park Place,Suite 600 INSURER C: <br /> Dublin,CA 94568-7983 <br /> INSURER D <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 15908234 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD MM/DD/YYYY MM/DD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TTED <br /> CLAIMS-MADE ❑ OCCUR PREM SESOEa occurrence) $ <br /> MED EXP(Any oneperson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER $ <br /> AUTOMOBILE LIABILITY (Ea acccidentSINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> $ <br /> UMBRELLA LAB I <br /> OCCUR EACH OCCURRENCE $ <br /> EXCESS LAB CLAIMS-MADE AGGREGATE $ <br /> DEC I I RETENTION$ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE FT WLR C73271290 E.L.EACH ACCIDENT $ 2,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A X — 07/01/2025 07/01/2026 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 <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 Fifth Asset,Inc DBA Debtbook through a co-employment agreement with TriNet HR III,Inc. <br /> List of additional covered entities under the above policy: <br /> dba Debtbook <br /> Waiver of subrogation in favor of City of Santa Ana,and its City Council,officers,officials,employees,agents,and volunteers.as respects of job performed by Fifth Asset,Inc DBA Debtbook as required by <br /> written contract. <br /> APPROVED <br /> CERTIFICATE HOLDER CANCELLATION BY Tu Tran Nguyen at 10:04 am,Nov 13,2025 <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Finance&Management Services Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Accounting Division ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 20 Civic Center Plaza M-17 <br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE A <br /> O'l C&Sh &eti/Lee9 (-youth 2Re <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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