COI - Barrett Business Services, inc. - Expires 2023-07-01ACORO�
CERTIFICATE OF LIABILITY INSURANCE
Acct#: 2875507
DATE (MM/DD/YYYY)
6/14/2022
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 CONTACT
NAME:
Lockton Companies PHONE 844-290-4908 I FAX
444 W 47th Street, Suite 900 (A/C No. Ext): (A/C, No):
E-MAIL Kansas City, MO 64112-1906 BBSIcerts@locictonaffinity.com
ADDRESS: Y•com
INSURER(S) AFFORDING COVERAGE NAIL #
INSURER A: Ace American Insurance Co. 22667
INSURED
Barrett Business Services, Inc.
L/C/F BETTER BUILT TRUSS, LLC
251 E 4TH ST
RIPON, CA 95366
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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR,/PARTNER/EXECUTIVE
A OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y/N
N/A X C51238862
7/1/2022 7/1/2023
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
EACH OCCURRENCE $
AGGREGATE $
X STATUTE I I EERH
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Policy State = CA
Waiver of Subrogation in favor of certificate holder when required by written contract
CERTIFICATE HOLDER CANCELLATION
City Of Gilroy
7351 Rosanna St
Gilroy, CA 95020
2,000,000
2,000,000
2,000,000
JUL - 6 2022
GILROY CITY CLERKS OFFICE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Workers' Compensation and Employers' Liability Policy
Named Insured
Barrett Business Services, Inc.
L/C/F BETTER BUILT TRUSS, LLC
251 E 4TH ST
RIPON, CA 95366
Endorsement Number
Policy Number
Symbol: Number: C51238862
Policy Period Effective Date of Endorsement
7/1/2022 TO 7/1/2023 7/1/2022
Issued By (Name of the Insurance Company)
Ace American Insurance Co.
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in Item
3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will
not enforce our right against the person or organization named in the Schedule, but this waiver applies
only with respect to bodily injury arising out of the operations described in the Schedule, where you are
required by a written contract to obtain this waiver from us.
You must maintain payroll records accurately segregating the remuneration of your employees while
engaged in the work described in the Schedule.
Schedule
1. ( ) Specific Waiver
Name of person or organization:
(X) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this
waiver.
2. Operations:
3. Premium:
The premium charge for this endorsement shall be INCLUDED percent of the California premium developed
on payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium: INCLUDED
WC 99 03 22
Authorized Agent
CAI ODD
JUL - 6 2022
GILROY CITY CLERK'S OFFICE
RE