2025-07-01 RCAC WC.pdf

6C3

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

12/09/2024

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

AON RISK SERVICES SOUTH INC

3550 LENOX ROAD NORTHEAST

SUITE 1700

ATLANTA GA 30326

CONTACT

NAME: Aon Risk Services, Inc of Florida

PHONE

(A/C, No, Ext): 833-506-1544

FAX

(A/C, No):

EMAIL

ADDRESS: work.comp@trinet.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : ACE American Insurance Company 22667

INSURED

TriNet Group, Inc. for leased workers to Rural Community Assistance Corporation 1 Park Place, Suite 600 Dublin, CA 94568-7983

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: 15840439 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

ADDL

INSR

SUBR

WVD

POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

LIMITS

COMMERCIAL GENERAL LIABILITY

EACH OCCURRENCE $

CLAIMS-MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence) $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $

OTHER $

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT

(Ea accident) $

ANY AUTO BODILY INJURY (Per person) $

OWNED

AUTOS ONLY

SCHEDULED

AUTOS BODILY INJURY (Per accident) $

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

PROPERTY DAMAGE

(Per accident) $

UMBRELLA LIAB OCCUR

EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DEC RETENTION $

A

WORKERS COMPENSATION

Y / N

N

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under

DESCRIPTION OF OPERATIONS below

N / A

WLR_C57667503

07/01/2024 07/01/2025

X

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT $ 2,000,000

E.L. DISEASE - EA EMPLOYEE $ 2,000,000

E.L. DISEASE - POLICY LIMIT $ 2,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation coverage is limited to worksite employees of Rural Community Assistance Corporation through a co-employment agreement with TriNet HR III, Inc..

Project: Contract#: CTR074231. Capacity Development/Technical Assistance to Small Public Drinking Water Systems

CERTIFICATE HOLDER CANCELLATION

Arizona Department of Environmental Quality 1110 W. Washington Street Phoenix, AZ 85007

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

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