Insurance - Global Power Group, Inc. - Workers Comp. 2019-04-17A� rti0
f! L/ CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
Acct#: 2524712
4/17/2019
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 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
CONTACT
NAME:
Willis Of Greater Kansas City Inc.
PHONE FAX
5700 W 112th Street, Ste. 100
844-290-4908
A/c o Ext : A/C No):
ADDRESS: BBSlcerts@locktonaffinity.com
Overland Park, KS 66211
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Ace American Insurance Co. 1,, 22667
INSURED
Barrett Business Services, Inc.
INSURER B:
INSURER C:
L/C/F GLOBAL POWER GROUP, INC.
8100 NE Parkway Drive, Ste. 200
MED EXP (Any one person) $
Vancouver, WA 98662
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
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
CLAIMS -MADE FIOCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $
POLICY 1 PRO JECT ❑ LOC
PRODUCTS - COMP/OP AGG $
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
Ea accident
BODILY INJURY (Per person) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident) $
NON -OWNED
HIRED AUTOS AUTOS
PeOr e RTY DAMAGE $
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
NIA
C66018660
5/1/2019
5/1/2020
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 2,000,000
E.L. DISEASE - EA EMPLOYEE, $ 2,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Policy State = CA
RE: All Operations. 30 day notice of cancellation provided when possible.
RECEIVED
k;tK I II-IL;A I L HULUtK MAT 11 1 /111`1 CANCELLATION
COSTA MESA SANITARY DISTRICT
290 Paularino Avenue
Costa Mesa, CA 92626
-PFO 613 q
Costa Mesa Sanitary District
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
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