Insurance Workers Comp Southern California Fleet Services 2016-06-06 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
6/6/2016
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 SUBROGRATION IS WAIVED,
subject to the terms 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 OnPoint Underwriting Inc.
8390 E Crescent Pkwy, Suite 200
Greenwood Village, CO 80111
CONTACT NAME: Steven McComb
PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699
EMAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A:ACE American Insurance Company 22667
INSURED
Barrett Business Services, Inc. L/C/F
SOUTHERN CALIFORNIA FLEET SERVICES, INC.
DBA SO CAL FLEET SVC RANCHO DOMINGUEZ
20420 SOUTH SUSANA ROAD
CARSON, CA 90810
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
ISSUES 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
TYPE OF INSURANCE ADDL
INSR
SUBR
WVD
POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJ-
ECT
LOC
EACH OCCURRENCE $
DAMAGE TO RENTED PREMISES (Ea
occurence)$
MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS SCHEDULED AUTOS
HIRED AUTOS NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)$
BODILY INJURY (Per person)$
BODILY INJURY (Per accident)$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB OCCUR
EXCESS LIAB OCCUR
DED RETENTION $
EACH OCCURRENCE $
AGGREGATE $
$
A WORKERS COMPENSATION AND EMPLOYERS'
LIABILITY Y/N
ANY PROPRIETOR/PARTNER/ EXECUTIVE
OFFICER/MEMBER EXCLUDED?Y
(Mandatory in NH) If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
RWC
C48810822
Covered states:
CA
05/01/16 05/01/2017 9 WC STATU-
TORY LIMITS OTH-
ER
E.L. EACH ACCIDENT $2,000,000
E.L. DISEASE - EA EMPLOYEE $2,000,000
E.L. DISEASE - POLICY LIMIT $2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
Costa Mesa Sanitary District
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
628 W. 19th Street AUTHORIZED REPRESENTATIVE
Costa Mesa CA 92627
Richard Poling
c) 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD.