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DATE (MMIDDIYYYY) <br /> AC40 CERTIFICATE OF LIABILITY INSURANCE <br /> 1104 i ' Acct#: 2848592 3/2/2021 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S) , AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Willis Towers Watson Midwest, Inc. NAME' <br /> 5700 W 112th Street, Ste , 100 UVCN o , 844-290-4908 AIC No): <br /> Overland Park, KS 66211 ADDRESS: BBSlcerts@locktonaffinity.com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : Ace American Insurance Co. 22667 <br /> INSURED INSURER B <br /> Barrett Business Services, Inc. <br /> L/C/F ROSS MCLAREN FUEL SYSTEMS, INC. INSURER C : <br /> 28030 VALCOUR DR <br /> CANYON COUNTRY, CA 91387 INSURER D : <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO CLAIMS-MADE El OCCUR PREMISES (Ea occurrence) $ <br /> MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY ❑ PROJECT D LOC PRODUCTS - COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> $ <br /> UMBRELLA LIABOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ $ <br /> WORKERS COMPENSATIONPER OTH- <br /> AND EMPLOYERS' LIABILITY YIN X STATUTE ER <br /> ANY PROPRIETOR/PARTNERIEXECUTIVE E. L. EACH ACCIDENT $ 2,000,000 <br /> A OFFICER/MEMBER EXCLUDED? El N / A 068652388 2/27/2021 2/1 /2022 2,000,000 <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ <br /> If yes, describe under 2,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS ] VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required) <br /> Policy State = CA <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ROSS MCLAREN FUEL SYSTEMS , INC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br /> 28030 Valcour Drive IN ACCORDANCE WITH THE POLICY PROVISIONS, <br /> Canyon Country, CA 91387 <br /> AUTHORIZED REPRESENTATIVE <br /> @ 1988-2014 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 ( 2014/01 ) The ACORD name and logo are registered marks of ACORD <br />