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COI - Barrett Business Services, Inc. - Expires 2024-07-01ACORU CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD YYW) Accta: 2875507 6/29/2023 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:SI UInsurance Services, LLC PHONE FAX 2502 N Rocky Point Drive fl41_290,4908 No : E-MAIL ADDRESS: BBSicerts@locktonaf6nity.com Tampa, FL 33607 INSURERS AFFORDING COVERAGE NAIC C INSURER A: Ace American Insurance Co. 22667 INSURED Barrett Business Services, Inc. INSURER B : INSURER C : LIC/F BETTER BUILT TRUSS, LLC 251 E 4TH ST RIPON, CA 95366 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 A DL SUSR POLICY NUMBER POLICY EFF fMMDIYYYY POLICY EXP MMIDD LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE S ❑ OCCUR dAMXCLAIMS-MADE PREMISES I& occurrence $ MED EXP (Any one person) $ PERSONAL 4 ADV INJURY S GENI AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S POLICY D PER C6 LOC PRODUCTS-COMP/OP AGG $ $ I OTHER: AUTOMOBILE _ LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY too, person) S ANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident S HIRED NONAWNED AUTOS ONLY AUTOS ONLY $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS-MAOE OEO RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER"EMBER EXCLUDED? (Mandatory In NH) NIA X C55528883 7/1/2023 7/1/2024 X PER Cni STATUTE ER E.L. EACH ACCIDENT $ 2000A00 E.L. DISEASE - EA EMPLOYEE S 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Police State bCA Waiver of Submit in favor of certificate holder when required bywritten1WJ en contract I n\I ���G v MD ILLS JUL 2 6 2023 GILROY CITY CLERK'S OFFICE City Of Gilroy 7351 Rosanna St Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i ACORD 25 (2016103) The ACORD name and logo are registered Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Barrett Business Services, Inc. Policy Number L/C/F BETTER BUILT TRUSS, LLC 251 E 4TH ST Symbol: WLR Number: C55528883 RIPON, CA 95366 Policy Period Effective Date of Endorsement 7/1 /2023 TO 7/1 /2024 7/1 /2023 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. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. 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: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 1.0 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: $0 Authorized Agent WC 90 03 75 (05/18)