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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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2016 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />D
<br />01/01/2024
<br />X
<br />01/01/2025
<br />10,000
<br />X
<br />D
<br />19399
<br />4,000,000
<br />QBE Specialty Insurance Company
<br />WC 080772118 (CA)
<br />X
<br />19445
<br />130004050
<br />10,000,000
<br />01/01/2025
<br />A
<br />X
<br />X
<br />C
<br />10,000,000
<br />01/01/2025 X
<br />ACE Property and Casualty Insurance Company
<br />X
<br />E&O / PROFESSIONAL LIABILITY
<br />01/01/2024
<br />CN101540284-ALL-ALL!-24-25
<br />X
<br />2,000,000
<br />19445
<br />Brian M Lynch
<br />01/01/2025
<br />NYC-010818482-09
<br />01/01/2024
<br />X
<br />4,000,000
<br />12/09/2024
<br />X
<br />01/01/2025
<br />insured and where required by written contract.
<br />12
<br />X
<br />01/01/2024
<br />1,000,000
<br />212 948 5527
<br />01/01/2025
<br />INCLUDING TECHNOLOGY E&O
<br />2,000,000
<br />X
<br />SIR:
<br />2,000,000
<br />2,000,000
<br />B
<br />Brian.Lynch@marsh.com
<br />01/01/2025
<br />01/01/2024
<br />01/01/2024
<br />X
<br />20699
<br />7620312 (AOS)
<br />EA. CLAIM/AGGREGATE
<br />5,000
<br />01/01/2024
<br />WC 080772117 (AOS)
<br />WC 080772119 (MA, ND, WA, WI, WY)
<br />#XOO G47439280 001
<br />2,000,000
<br />officers, employee and agents is/are included as Loss Payee regarding Crime Policy where required by written contract. Waiver of subrogation is applicable where required by written contract. The Workers'
<br />Compensation policy includes an Alternate Employer endorsement. General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named
<br />Re: Contract #2017552, Third Amendment to Agreement.
<br />City of Pleasanton, its officers, employee and agents is/are included as additional insured (except workers’ compensation, professional liability and crime) where required by written contract. City of Pleasanton, its
<br />AIU Insurance Co
<br /> dba Ajilon Professional Staffing Accounting Principals
<br /> Jacksonville, FL 32246 4800 Deerwood Campus Parkway, Building 800
<br />2,000,000
<br />National Union Fire Insurance Co.
<br />X
<br /> 1166 Avenue of the Americas MARSH USA, LLC.
<br /> Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 New York, NY 10036
<br />B
<br />GL 9952669
<br />National Union Fire Insurance Co. Of Pittsburgh, PA
<br />N
<br /> Pleasanton, CA 94566
<br /> City Of Pleasanton
<br /> PO Box 520
<br />01/01/2024
<br />7620311 (FL)
<br />D
<br />11515
<br />2,000,000X
<br />X
<br />212 345 0557
<br />CONTRACTUAL LIABILITY
<br />X
<br />E
<br />10,000,000
<br />01/01/2025
<br />X
<br />Docusign Envelope ID: 60B53518-89C9-426B-B29A-7318298AEA52
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