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Docusign Envelope ID: 31630204-995B-4DCC-A316-0219109A1493 <br />Contractor Information <br />Legal Entity Name <br />RICHARD SMITH <br />Legal Entity Type <br />Sole Proprietorship <br />Status <br />Active <br />Registration Number <br />1000007036 <br />Registration effective date <br />7/1/2022 <br />Registration expiration date <br />6/30/2024 <br />Mailing Address <br />541 WEST CAPITOL EXPWY PMB 287 SAN JOSE 95136... <br />Physical Address <br />135 Lewis Road SAN JOSE 95111 CA United States of A... <br />Email Address <br />Trade Name/DBA <br />BAY AREA TREE SPECIALISTS <br />License Number(s) <br />CSLB:836837 <br />Legal Entity Information <br />Sole Proprietor Name: <br />Workers Compensation <br />Do you lease employees No <br />through Professional <br />Employer Organization <br />(PEO)?: <br />Please provide your <br />current workers <br />compensation insurance <br />information below: <br />PEO Name <br />PEO Information <br />PEO (866) 800-0785 PEO <br />Phone Email <br />SOUTH EAST PERSONNEL <br />LEASING INC. <br />Registration History <br />Effective Date <br />Expiration Date <br />5/25/2018 <br />6/30/2019 <br />5/25/2017 <br />6/30/2018 <br />7/15/2016 <br />6/30/2017 <br />6/29/2015 <br />6/30/2016 <br />1/27/2015 <br />6/30/2015 <br />7/1/2019 <br />6/30/2021 <br />7/1/2021 <br />6/30/2022 <br />7/1/2022 <br />6/30/2024 <br />Insured by Carrier <br />Policy Holder Name:BAY AREA TREE SPECIAISTSInsurance Carrier: <br />BENCHMARK INSURANCE COMPANYPolicy Number:CST5014698Inception date: <br />12/31/2018Expiration Date:12/31/2022 <br />