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Docusign Envelope ID: 31630204-995B-4DCC-A316-0219109A1493 CERTIFICATE OF LIABILITY INSURANCE Date(MM/DD/YYYY) 11/20/2024 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 be endorsed. if SUBROGATION IS WAIVED, subject to the temts 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: Plymouth Insurance Agency, Inc. 2739 U.S. Highway 19 North Holiday, FL 34691 co.TACr PHONE 1-800-966-5562 FA C No INSURER(S) AFFORDING COVERAGE NAIC # Insurer A: State National Insurance Company, Inc. 12831 Insured: South East Employee Leasing Services, Inc. (LCF) Richard Smith dba Bay Area Tree Specialists 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer B: Insurer C: Insurer D: Insurer E: Insurer F: 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 LTR I TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM DD YYYY I POLCY EXP MM DID LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1OCCUR EACH OCCURENCE $ rriirrpnrp)$ MED EXP (Any oneperson) PERSONAL & ADV INJURY GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC PRODUCTS - COMP OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED I P AUTOS OMBIN D INGLE LIMIT BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE Per Accident $ UMBRELLA LIAB 'InEIES5MB OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ RETENTION $ A WORKERS AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I - LV CWC71949-1529 1/1/2024 1/1/2025 X W RY IMITS OER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (California Operations Only) Coverage is extended to assigned employees as approved and assigned by South East Employee Leasing Services, Inc. but not subcontractors or nonassigned employees of: Richard Smith dba Bay Area Tree Specialists Project Name: WAIVER OF SUBROGATION APPLIES IN FAVOR OF CITY OF PLEASANTON. ISSUE 07-26-24 (KILT). REISSUE 11-19-24 (KILT). REISSUE 11-20-24 (TD) CERTIFICATE HOLDER CANCELLATION CITY OF PLEASANTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. BOX 520 AUTHORIZED REPRESENTIVE - PLEASANTON, CA 94566 � .,-y-z' ✓ f y _, ©1998-2010 ACORD CORPORATION. All rights reserved. ACORD 2S (2010/OS) The ACORD name and logo are registered marks of ACORD