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12/13/2024 <br />Marsh Affinity <br />a division of Marsh USA LLC. <br />PO BOX 14404 <br />Des Moines, IA 50306-9686 <br />Marsh Affinity <br />800-743-8130 <br />ADPTotalSource@marsh.com <br />AIU Insurance Company 19399 <br />A N 07/01/2024 07/01/2025 <br />2,000,000 <br />2,000,000 <br />2,000,000 <br />ADP TotalSource FL XVI, Inc. <br />5800 Windward Parkway <br />Alpharetta, GA 30005 <br />L/C/F: <br />Pleasanton Golf, LLC <br />DBA Callippe Preserve Golf Course <br />8500 CLUBHOUSE DRIVE <br />Pleasanton, CA 945660000 <br />WC 088410811 CAX <br />All worksite employees working for Pleasanton Golf, LLC DBA Callippe Preserve Golf Course paid under <br />ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. <br />Proprietor/Partner/Executive Officer/Member are not excluded as long as they are in the ADPTS <br />payroll or have completed the SEI Participation Addendum. WAIVER OF SUBROGATION IN FAVOR OF <br />CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY Pleasanton Golf, LLC DBA Callippe Preserve Golf <br />Course AS REQUIRED BY WRITTEN CONTRACT. <br />City of Pleasanton <br />P.O. Box 520 <br />Pleasanton, CA 94566 <br />X <br />Docusign Envelope ID: 4B46EC68-D08F-48D9-8216-B13D1BA06454