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GOVESTA -02 PPISA,NO
<br />�+►�t ►R� CERTIFICATE OF LIABILITY INSURANCE DATE 14120YYYY)
<br />�— ►-'"' 6P1412016
<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 P'ROD'UCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME:
<br />CTK North American Insurance Services, LLC I INSURICA PHONE FAX
<br />1240 North Lakeview Avenue, #240 Arc No Ext : (714) 779
<br />Iarcua}: (714) 779 4129
<br />E -MAIL ......�
<br />Anaheim, CA 92807 ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE ( NAIC A
<br />INSURED
<br />Government Staffing Services
<br />P.O. Box 718
<br />Imperial Beach, CA 91933
<br />INSURER A: Zurich American Insurance Co. of IL 127855
<br />INSURER B:America'n Guarantee and Liability Ins. Co. 26247
<br />INSURER C'
<br />INSURER D; _ .._._.
<br />INSURER E
<br />COVER Ar3E8 CERTIFICATE NUMBER- RFVISInN NI1MRI=R-
<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 CONDITION'S OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NSR, J.J . . ...... ..... ....... -.. ADDL SVBR POLICY EFF POLICY EXP - ............ ...... ._.........
<br />ILTR TYPE OF INSURANCE IN D POLICY NUMBER MMIDD1YYYY MMIDDlY'YYY) LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL. LIABILITY
<br />,NNL7r
<br />__ ........ _,
<br />EACH OCCURRENCE
<br />$ 1,.000,000
<br />CLAIMS -MADE OCCUR
<br />PRA969906304
<br />05/1012016
<br />DXM� E TORENTED.
<br />05110!2017 PREMISES,,.(Ea mccurremce
<br />_
<br />5 100,000
<br />MED EXP (Any one person)
<br />5 10,000
<br />PERSONAL . &ADVINJURY
<br />$ 1,000,000'
<br />$ 2,000000
<br />GEN'LAGGREGATELIMITAPPLIESPER:
<br />GENERAL AGGREGATE
<br />.N«
<br />PRO-
<br />POLICY JODU
<br />ECT LOC
<br />,.
<br />PRODUCTS COMPYCPACG
<br />_.,.... ........ -.
<br />$ 2,000,000
<br />._ .. —...
<br />OTHER:
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />...
<br />C COMBINED SINGLE LIMIT
<br />(Ea accldent)
<br />$ 00
<br />1,0 ,000
<br />A
<br />ANY AUTO
<br />PRA969906304
<br />05110/2016
<br />0511012017
<br />� BODILY INJURY (Per person)
<br />._
<br />$
<br />..._.....
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />I BODILY INJURY (Per accident)
<br />_.._..
<br />NON!- OWNED'
<br />HIRED AUTOS AUTOS
<br />_._.
<br />j
<br />PROPERTY
<br />�.,LPerPERTYl AMAGE�...
<br />m ..
<br />._...
<br />$,
<br />_.......
<br />':..
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />I,
<br />EACH OCCURRENCE,
<br />$ 1,000,000
<br />B
<br />EXCESS LIAR.
<br />CLAWS -MADE
<br />�UMB948734704
<br />0511012016
<br />0511012017
<br />AGGREGATE
<br />$ 1,000,000
<br />DEC) X I RETENTION $ 0
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRtlETOR /PARTNERIEXECUTIVE
<br />OFFIICERWEMBEREXC'LUDED? �
<br />andatory in NH)
<br />N/A
<br />PER OTH-
<br />STATUTEm .... ER
<br />"'
<br />..L EACH ACCIDENT
<br />......'. "..,....
<br />$
<br />E.L DISEASE -EA EMPLOYEE
<br />$
<br />If
<br />If yes, describe under
<br />DESCRIPT'lON OF OPERATVONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />- ,.... -.. _._......_.
<br />$
<br />A
<br />,Crime
<br />PRA96990630'4
<br />0511012016
<br />0511012017
<br />$100,000 $2,500 Ded
<br />A
<br />Professional L°labili
<br />PRA969906304
<br />0511012016
<br />05/1012017
<br />$1m1$2m $1000 Ded
<br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule,, may be attached. If more space is required)
<br />Cyber Liability: BCS Ins. Co.1 RPS- P- 01 10241110123115-10123116 1$1,000 „0'00
<br />`
<br />Schedule of Named Insured(s)
<br />Government Staffing Service dba: Herrera & Associates Staffing Servces,,,,X” (°
<br />�~
<br />Government Staffing Service dba: Munigroup,Government Staffing Service dba. Muni'temps
<br />Government Staffing Service dba: Munstaff
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS..
<br />AUTHORIZED REPRESENTATIVE
<br />PAV/000�1
<br />Q 1988 -2014 ACORD CORPORATION. All .rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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