HomeMy WebLinkAboutMINOR MOD CERTIFICATE OF LIABILITY INFO 8.8.18A CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
12/7/2017
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($).
PRODUCER Willis Towers Watson CONTACT NAME Fresno
12980 Metcalf Ave Suite 500 PHONE (A/C, No Ext): (559) 431 -5455 FAX (A/C, NO). (360) 828 -0699
Overland Park KS 66213 EMAIL ADDRESS: Valerie.William @bbbsihq.com - . - . -...w.
INSURER(S) AFFORDING COVERAGE
INSURER A: ACE American Insurance Company ?22667
INSURED INSURER B I
Barrett Business Services, Inc. UC /F INSURER C
LARRY & CLIFF ENTERPRISES, INC. DBA LC
SERVICES INSURER E
r
3887 N VALENTINE
FRESNO, CA 93722
cnVFRnGFS CERTIFICATE NUMBER: RGVWIWile 114 IKJclN.
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
EACH OCCURRENCE
$
DAMAGE TO RENTED PREMISES (Ea
occurence)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F� OCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$
POLICY PROJ- LOC
E
7 CT
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
ALL OWNED AUTOS []SCHEDULED AUTOS
HIRED AUTOS NON -OWNED AUTOS
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
OCCUR
$
DED
RETENTION $
A
WORKERS COMPENSATION AND EMPLOYERS'
LIABILITY Y/N
ANY PROPRIETOR /PARTNER/ EXECUTIVE Y
OFFICER/MEMBER EXCLUDED?
N / A
RWC
C64402328
Covered states:
11/01/17
11/01/2018
�/
WC STATU-
TORY LIMITS
OTH-
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
CA
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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
Proof of Coverage
POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Authorized
Rep AS
n nn11Ml/ ATI(lAI All
ACORD 26 (2010/05)
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The ACORD name and logo are registered marks of ACORD.