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COI - Modern HR Inc. Labor Contractor - Expires 2022-12-10>® CERTIFICATE OF LIABILITY INSURANCE I OATE (MMlOO/VYYY) 12/02/2021 -----, 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 have ADDITIONAL INSURED provisions or 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 \,UNI ACT NAME: Doug Jones mg~Jo. Extl: ( 480) 951-4177 f ~&.Nol: (480} 951-4266 c/o Artex Risk Solutions, Inc. E-MAIL SDLBSD.Certificates@artexrisk.com P.O. Box 13838 ADDRESS: Scottsdale, /J.Z 85267 INSURER(S) AFFORDING COVERAGE I NAfC# INSURER A: Zurich"American Insurance Comoany 16535 INSURED INSURERS: Modern HR Inc Labor Contractor, for co-employees of: Innovative Claim Solutions Inc ·-··-··•··-···-·-----·-·-·-•···-----·-----.. ----··"·"-----.. --·······-·-----·---.. ---------... ·----·--·-·---7590 N Glenoaks Blvd Suite 200 INSUREF!C: Burbank, CA 91504 INSURERD: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER:21CA155861955 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POL!GlES OF INSURANCE USTED BELOW HAVt:: BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 COI\IDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ~~~~l~:~1 I ,:gtt,%Yv'€/'fy1 ! ,:g?b%'f.R-hl I LIMITS LTR POLICY NUMBER COMMERCIAL GENERAL LIABILITY I I LEACH OCCURRENCE $ ,-LJ CLAIMS-MADE i---1 OCCUR ! ~~~]W,~~~ence\ s f--··-·~·--· ____ ,. ___ , ···---· ----·-------·-··-··-· --.. ···-· -------·-·· --. -_ MED EXP_(Any one person) _____ _$ ______________ ....... ___________ PERSONAL & ADV INJURY s I-GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s r-i POL CY n PRO-r-i I ! PRODUCTS -C:2_~!::iOP AGG $ ---·I I L __ .] JECT L ___ _j LOC I i ··-----·-·---····----I OTHER: 1 ! $ AUTOMOBILE LIABILITY I ! COMBINED SINGLE LIMIT s I (Ea aceidentl n ANY AUTO BODILY INJURY (Per person) $ ··-----1 -•-•-.--I ---------·-----· .. ·-·-··------------------------------··---------· I OWNED SCHEDULED BODILY INJURY (Per accident) S ..---1 AUTOS ONLY AUTOS I HIRED --NON-OWNED /ROPERTY DAMAGE __J AUTOS ONLY AUTOS ONLY Per accident' s -i $ UMBRELLA LIAS WoccuR EACH OCCURRENCE $ --EXCESSUAB I I CLAIMS-MADE AGGREGATE $ . OED I ' ! RETENTIONS $ WORKERSCOMPENSATION f X i PER I I OTH• ANO EMPLOYERS' LIABILITY y I N ! STATUTE I I ER A ! ANYPROPRIETOR/PARTNER/EXECUT!VE □ NIA WC 54-70-740-08 12/10/2021 12/i0/2Q22 ! EL.EACHACCIOENT i $ 1,000,000 j OFFICER/MEMBER EXCLUDED? i (Mandatory in NH) I I E.L.DlSEASE-EAEMPLOYEEt_$ •' ----__ 1,000,000 _ r tl yes, describe under I I ' i E.L. DISEASE -POLICY LIMIT : $ i,000,000 i DESCRIPT!ON OF OPERATIONS below I ' i i ! I l ! Location Coverage Period: 12/10/2021 12/10/2022 J Client# 1 0838-CA I ! DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarl<s Schedule, may be attached if more space is required) Coverage is provided for Innovative Claim Solutions Inc only those co-employees 11344 Coloma Rd Ste 7 45 of, but not subcontractors Gold River, CA 95670 lo: CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HR Director/Risk Manager THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE i ~~z~ © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and loao are reaistered marks of ACORD 2• of2 7225