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ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER:FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br />LHH Recruitment Solutions, Inc. <br />4800 Deerwood Campus Pkwy Bldg 800 <br />Jacksonville, FL 32246 <br />City of Pleasanton is included as Additional Insureds with respect to General Liability and Auto Liability where <br />required by written contract. <br />General Liability and Auto Liability are primary and non-contributory over any existing insurance and limited to <br />liability arising out of the operations of the named insured and where required by written contract. <br />Waiver of subrogation is applicable to General Liability, Auto Liability and Workers Compensation where required by <br />written contract, as permitted by law. <br />The Workers' Compensation policy includes an Alternate Employer endorsement. <br />City of Pleasanton is included as Loss Payee regarding Crime Policy where required by written contact. <br />INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399 <br />POLICY NUMBER: 024061368 EFF DATE: 01/01/2025 EXP DATE: 01/01/2026 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation E.L. EACH ACCIDENT $2,000,000 <br />Employers' Liability - Wisconsin E.L. DISEASE - EA EMP $2,000,000 <br />Per Statute E.L. DISEASE - POLICY $2,000,000 <br />INSURER AFFORDING COVERAGE: National Union Fire Insurance Company of Pittsburgh NAIC#: 19445 <br />POLICY NUMBER: 024061369 EFF DATE: 01/01/2025 EXP DATE: 01/01/2026 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation E.L. EACH ACCIDENT $1,000,000 <br />Employers' Liability - Ohio E.L. DISEASE - EA EMP $1,000,000 <br />Per Statute E.L. DISEASE - POLICY $1,000,000 <br />INSURER AFFORDING COVERAGE: AXIS Insurance Company NAIC#: 37273 <br />POLICY NUMBER: P-001-000326514-06 EFF DATE: 01/01/2025 EXP DATE: 01/01/2026 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Crime with Third Party Coverage Per Occurr/Aggregate $10,000,000 <br />2 3 <br />Willis Towers Watson Southeast, Inc. <br />See Page 1 <br />See Page 1 See Page 1 See Page 1 <br />25 Certificate of Liability Insurance <br />W39520566CERT:4020945BATCH:27992798SR ID: <br />Docusign Envelope ID: FBB9CD5D-AACA-4324-A57F-F244E3BBC3C6