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Aq.,., aro. CERTIFICATE OF LIABILITY INSU DICE DATE IMMIDOr , ��' � 8YYYY) 872112p'1 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 Or INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTI�CATE HOLDER. _ IMPORTANT: If the cartlficate holder is an ADDITIONAL INSURED, the polloy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an andorsoment. A statement on this certificate does not confer rights to the certificate holder In lieu of such andorsement(s), PRODUCER Assurance Agency, Ltd. CONT a ME:: Chris Dalstrom ......-....- NE {847) 463 7218 One Centur y Centre tAIq..Nn Pau. _,.._ - 1750 E,. Golf Road e-MAD Bj7DREss cdaistromassurances Sun .00m Schaumburg IL 60173- INSURER[61 AFFORDING covP�uc NAICE _ INSURSRA: Protective lnsurance CDmpany �12416 INSURED Personnel Staffing Group, LLC INSURER 8 -------.--.-------------.-.--..------- dba KSS Staffing INeuRpR c;____..m__._._...._.-._--.__._m_m.m_.__.____ 1751 Lake Cook Road, Suite 600 INSURER D: Deerfield IL 6gg15 ....-..-..----------- --.,..__.. ......_ .....INSURER E: INSURER P: GUVCttALieO (;tit I[FICA; I NUMBER: 443688611 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCF LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 EACH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ...-._--..................._..._..-�.�OLICYEFP INSft' ADOC�"$0@RT.------------- LTR TYPE OF INSURANCE I POLICY NUMBER MMIDDIYYYY POLICYEXP .___...� MIDDM'YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S QOMMEROIAL GENERAL LIABILITY 1 A AGc LO RENT R>iMISE iEs_occurrOnGG "'_ CLAIMS MAUE OCGUft ,.r ..... MED RFP(!ny one I.Don S_ PERSONAL A ADV INJURY y $ !'PN'I. AGGREGATE LIMIT APPLE 9 PER: ;PRODUCTS -COMPIOPAGG I .� PaLICY _PRO- . LOC ( ------- AUTOMOBILE LIABILITY t ` ODBY de 1URY(Pa LIMIT S Ca ( ANY AUTO 6661LY INJURY (Par P sco) �3 --- I ALL ANYAETIED 1 (Par aoo daYlb) S RFork NO 10-4WFIED - F--� HIRLDAITNS `- AUT'GA w—CU k AROPFR7Y,.�.-0MAG t I 1 5 Intent! LA LIAR I OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS4APEi t _ AGGREGATE $ DED RETEiJ'nGPIS-._.�.....�..-^. S A WORKERS COMPENSATION NAOD1d#B EIJ620f8 SfJD D9 ,—X 'A�STATU 10 H — AND EMPLOYERS LLASI." YIN ...... TORY_LIMLTS 1 E ........__,..- ANYPROPRIETORMARTNEWRXECUTIVE OFFICEMMEMBER EC LIDDED? M1I N/A E.L. EACHACCIDENn Sf,LED .are (Mandatoey In NYtj i If yes. de9arl9a trotter tl DISEASE -EA FPAPLf:YEEt,000.p0G . DESCRIPTION 9F OPERATIONS below E_A19 CY LIMIT a^ I coo Nor, DESCRIPTION OF O eetATIONS I LOCATIONS I VEHICLES (Attach ACORD IN, Additional Remarks Selman , If mom space a required) Proof of Insurance RE, Employees assigned by All City Management Services ohs The Grossing Guard Company 10440 Pioneer Blvd Suite 5, Santa Fa Springs CA 90670 A Waiver m Subrogation in favor of the Certificate Holder applies to the Worker's Compensation polio y, when required by written contract end where allowed by law. TION`" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 60 Civic Center Plaza --- Santa Ana CA 92702 auTHDRIzen REPRESENTanvE r 19-88.2,010 AOORD CORPORATION. All rights reserved. ACORD 25 (2010105) Tine ACC,ZD name and logo are registered marks of ACORD ro � qr' 1+