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Insurance - Global Power Group, Inc. - Workers Comp 2018-04-20AC"#?I ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/20/2018 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 Willis Towers Watson CONTACT NAME: San Diego 12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext): (858) 314-1100 FAX (A/C, NO): (360) 828-0699 Overland Park KS 66213 EMAIL ADDRESS: EIke.Wohlgemuth@bbsihq.com LIMITS INSURER(S) AFFORDING COVERAGE NAIC # LTR INSURERA: ACE American Insurance Company 22667 INSURER B: INSURED Barrett Business Services, Inc. UC/F INSURER C: GLOBAL POWER GROUP, INC. INSURER D: 12060 WOODSIDE AVE INSURER E: LAKESIDE, CA 92040 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 CONTRACTOR 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 TYPE OF INSURANCE ADEL SUER POLICYNUMBER POLICYEFF POLICY EXP LIMITS LTR INSR MD (MMIDD/YYYY) (MWDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea CLAIMS -MADE EJ OCCUR occurems) $ MED EXP (Any one person) $ PERSONAL S ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ POLICY PROD- LOC S ECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea acciden0 $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS e BODILY INJURY (Per acquent) $ PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB OCCUR AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 05/01/18 05/01/2019 `/ WCSTATU- OTH- LIABILITY Y/N C65184722 TORY LIMITS ER E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNERI EXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS be. N/A Covered States: CA E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICK9hYta Aj1Jjij>,19j, Additional Remarks Schedule, if more specs is required) MAY 0 3 2018 CERTIFICATE HOLDER COShl — 1i­,,-YDbtrjcJCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE COSTA MESA SANITARY DISTRICT POLICY PIROVISIONS.ON DATA HEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 290 Paularino Avenue /L AUTHORIZED REPRESENTATIVE Costa Mesa Ca 92626 (v 1 Authorized Rep c) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: M A ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED: Barrett Business Services, Inc. L/C/F Lockton Affinity GLOBAL POWER GROUP, INC. 12060 WOODSIDE AVE POLICY NUMBER LAKESIDE, CA 92040 RWC C65184722 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 05/01/18 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: COSTA MESA SANITARY DISTRICT ADDRESS: 290 Paularino Avenue Costa Mesa Ca 92626 RE: All Operations. 30 day notice of cancellation will be provided when possible. ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD.