CTR078646_COI.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

9/11/2025

Marsh & McLennan Agency LLC 20 North Martingale Road Suite 100 Schaumburg IL 60173

Joe Flaherty

(847) 908-8719 (847) 440-9126

Joe.Flaherty@MarshMMA.com

Carolina Casualty 10510 TRYFINC-01 StarNet Insurance Co. 40045

Tryfacta, Inc.

4637 Chabot Dr, Suite 100 Pleasanton CA 94588

Philadelphia Indemnity Insuran 18058

1191575329

C X 1,000,000 X 100,000

5,000

1,000,000

2,000,000 X X X

PHPK2699172000 11/1/2024 1/1/2026

2,000,000

C 1,000,000

X X

PPK2699307000 11/1/2024 1/1/2026

C X X 5,000,000PHUB915647000 11/1/2024 1/1/2026

5,000,000

Prod/Comp Ops 5,000,000 A B

X

N

KRM698158054

KRM403168306

4/16/2025 4/16/2025

4/16/2026 4/16/2026

1,000,000

1,000,000

1,000,000 C C C

Professional Liability Crime (incl 3rd Party) Employment Practices Liability

PHPK2699172000

PHPK2699172000

PHPK2699172000

11/1/2024 11/1/2024 11/1/2024

1/1/2026 1/1/2026 1/1/2026

Occ.: $1M Limit: $1M Claim: $1M

Agg.: $2M

Agg.: $1M

Proof of Insurance.

Umbrella Follows Form over General Liability, Professional Liability, and Employers' Liability policies.

Additional Coverages:

Medical Professional Liability through Landmark American Insurance Co (LHM860285), Eff 8/5/24 - 1/1/26: $1M per Claim / $3M Aggregate Sexual Abuse & Molestation Aggregate of $2M is included on the Medical Professional Liability policy.

See Attached...

ARIZONA DEPARTMENT OF HEALTH SERVICES

150 North 18th Ave, Suite 530 Phoenix AZ 85007

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

TRYFINC-01

1 1

Marsh & McLennan Agency LLC Tryfacta, Inc.

4637 Chabot Dr, Suite 100 Pleasanton CA 94588

25 CERTIFICATE OF LIABILITY INSURANCE

Cyber Liability through At-Bay Specialty Insurance Co (AB665352401), Eff 5/22/25 - 1/1/27: $5M Limit (Incl. $1M Tech E&O Sublimit)

RE: REQUEST FOR PROPOSAL No.: BPM006391 - REGISTRY STAFFING FOR THE ARIZONA STATE HOSPITAL

Contractual Liability applies to the General Liability policy per policy terms, conditions, and exclusions.

Sexual Abuse and Molestation coverage is included on General Liability policy for a $1M sublimit.

The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are additional insureds for General Liability on a primary and non-contributory basis where required by written contract or agreement subject to the provisions and limitations of the policy(ies).

Waiver of Subrogation in favor of the additional insureds applies to the General Liability and Workers' Compensation policies where required by written contract or agreement per policy terms and conditions.

Insured Owns No Autos.

30 Day Notice of Cancellation Applies.

POLICY NUMBER: COMMERCIAL GENERAL LIABILITY

CG 20 26 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:

1. In the performance of your ongoing operations;

or

2. In connection with your premises owned by or rented to you.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of

Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

Name Of Additional Insured Person(s) Or Organization(s):

Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional Insured for ‘bodily injury”, “property damage” or “personal and advertising injury” but only for liability arising out of the negligence of the Named Insured.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

PHPK2699172-000

PI-GLD-TS (11/15)

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

GENERAL LIABILITY DELUXE ENDORSEMENT:

TEMPORARY STAFFING

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording.

Coverage Applicable Limit of Insurance Page

Damage to Premises Rented to You $1,000,000 2

Expected or Intended Injury – Property Damage Included 2

Limited Rental Lease Agreement Contractual Liability $50,000 2

Non-Owned Watercraft Less than 58 feet 3

Damage to Property You Own, Rent or Occupy $30,000 3

Medical Payments $20,000 3

Medical Payments Reporting Period 3 Years 3

Athletic Activities Amended 3

Supplementary Payments – Bail Bonds $2,500 4

Supplementary Payments – Loss of Earnings $500 per day 4

Employee Indemnification Defense Coverage $25,000 4

Who Is An Insured Additional Insured – Newly Acquired or Formed Organization Additional Insured – Broadened Named Insured Additional Insured – Blanket Additional Insureds When Required by Contract

Included 4

Duties in the Event of Occurrence, Offense, Claim or Suit Included 4

Transfer of Rights of Recovery Against Others To Us Clarification 5

Liberalization Included 5

Unintentional Failure to Disclose Hazards Included 5

Bodily Injury – Includes Mental Anguish Included 5

Personal and Advertising Injury – Includes Abuse of Process, Discrimination

Included

Other Insurance – Primary Clarification Clarification 6

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Staffing Services Exclusions Clarification 7

Staffing Services Definitions Clarification 8

A. Damage to Premises Rented to You

If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part:

1. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of:

a. $1,000,000; or

b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit.

This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof;

2. The word fire is changed to fire, lightning, explosion, smoke, or leakage from automatic fire protective systems where it appears in:

a. The last paragraph of SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND

PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions;

b. SECTION III – LIMITS OF INSURANCE, Paragraph 6.; and

c. SECTION V – DEFINITIONS, Paragraph 9.a.; and

3. The words fire insurance are changed to insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems where it appears in SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess Insurance.

B. Expected or Intended Injury – Property Damage

SECTION I – COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE

LIABILITY, 2. Exclusions, Paragraph a. Expected Or Intended Injury is deleted in its entirety and replaced by the following:

a. Expected Or Intended Injury

“Bodily injury” or “property damage” expected or intended from the standpoint of the insured.

This exclusion does not apply to “bodily injury” or “property damage” resulting from the use of reasonable force to protect persons or property.

C. Limited Rental Lease Agreement Contractual Liability

LIABILITY, 2. Exclusions, Paragraph b. Contractual Liability is amended by adding the following:

Based on the named insured’s request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

This coverage extension only applies to rental lease agreements and is excess over any renter’s liability insurance of the client.

D. Non-Owned Watercraft

LIABILITY, 2. Exclusions, g. Aircraft, Auto Or Watercraft, Paragraph (2) is amended to read as follows:

(2) A watercraft you do not own that is:

(a) Less than 58 feet long; and

(b) Not being used to carry persons or property for a charge;

This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent.

E. Damage to Property You Own, Rent or Occupy

LIABILITY, 2. Exclusions, j. Damage To Property, Paragraph (1) is deleted in its entirety and replaced with the following:

(1) Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another’s property, unless the damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision.

F. Medical Payments

1. If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part the Medical Expense Limit is changed subject to all of the terms of SECTION III – LIMITS OF INSURANCE to the greater of:

a. $20,000; or

b. The Medical Expense Limit shown in the Declarations of this Coverage Part.

2. Under SECTION I – COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 1.

Insuring Agreement, Paragraph a., Item (b) is amended to read:

(b) The expenses are incurred and reported to us within three years of the date of the accident; and

G. Athletic Activities

SECTION I – COVERAGES, COVERAGE C MEDICAL PAYMENTS, 2. Exclusions, Paragraph e.

Athletics Activities is deleted in its entirety and replaced with the following:

e. Athletics Activities

To a person injured while taking part in athletics.

H. Supplementary Payments

SECTION I – COVERAGES, SUPPLEMENTARY PAYMENTS – COVERAGES A AND B, Items 1.b.

and 1.d. are amended as follows:

b. The limit for the cost of bail bonds is changed from $250 to $2,500; and

d. The limit for loss of earnings is changed from $250 a day to $500 a day.

I. Employee Indemnification Defense Coverage

SECTION I – COVERAGES, SUPPLEMENTARY PAYMENTS – COVERAGES A AND B is amended to include the following:

We will pay, on your behalf, defense costs incurred by an “employee” in a criminal proceeding.

The most we will pay for any “employee” who is directly involved in a criminal proceeding is $25,000 regardless of the numbers of "employees," claims or “suits” brought or persons or organizations making claims or bringing “suits.”

J. Who is An Insured

SECTION II – WHO IS AN INSURED is amended as follows:

1. Newly Acquired or Formed Organization

If coverage for newly acquired or formed organizations is not otherwise excluded from this Coverage Part, Paragraph 3.a. is amended to read:

a. Coverage under this provision is afforded until the end of the policy period;

2. Each of the following is also an insured:

a. Broadened Named Insured – Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance.

b. Blanket Additional Insureds When Required by Contract – Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations.

The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in SECTION III – LIMITS OF INSURANCE.

c. Interns – Your interns only while performing duties related to the conduct of your business.

d. Contractors – Any individual or organization under written contract or written agreement with you who provides “staffing services” on your behalf and at your direction for your clients.

K. Duties in the Event of Occurrence, Offense, Claim or Suit

1. SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, 2.a. the requirement that you must see to it that we are notified as soon as practicable of an “occurrence” or an offense, applies only when the “occurrence” or offense is known to:

a. You, if you are an individual;

b. A partner, if you are a partnership; or

c. An "executive officer" or insurance manager, if you are a corporation.

2. SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, 2. b. the requirement that you must see to it that we receive notice of a claim or “suit” as soon as practicable will not be considered breached unless the breach occurs after such claim or “suit” is known to:

a. You, if you are an individual;

b. A partner, if you are a partnership; or

c. An "executive officer" or insurance manager, if you are a corporation.

L. Transfer of Rights of Recovery Against Others To Us

SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us includes the following clarification:

Therefore, the insured can waive the insurer’s rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract.

M. Liberalization

SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following additional condition:

Liberalization

If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state.

N. Unintentional Failure To Disclose Hazards

SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following additional condition:

Unintentional Failure To Disclose Hazards

It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure.

O. Bodily Injury – Mental Anguish

SECTION V – DEFINITIONS, Paragraph 3. is amended to read:

“Bodily injury”:

a. Means bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and

b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time.

P. Personal and Advertising Injury – Abuse of Process, Discrimination

If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of “personal and advertising injury” is amended as follows:

1. SECTION V – DEFINITIONS, Paragraph 14., Item b. is revised to read:

b. Malicious prosecution or abuse of process;

2. SECTION V – DEFINITIONS, Paragraph 14. is amended to include the following:

“Personal and advertising injury” also means discrimination based on race, color, religion, sex, age or national origin, except when:

a. Done intentionally by or at the direction of, or with the knowledge or consent of:

(1) Any insured; or

(2) Any executive officer, director, stockholder, partner or member of the insured; or

b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; or

c. Directly or indirectly related to the sale, rental, lease or sublease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or

d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling.

The above does not apply to fines or penalties imposed because of discrimination.

Q. Section IV – Commercial General Liability Conditions is amended by the addition of the following:

The following language is added to Item 4. Other Insurance:

Insurance under this endorsement is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization.

This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or “occurrence” we cover for this Additional Insured.

R. Staffing Services Exclusions

The following exclusions are added to SECTION I – COVERAGES, COVERAGE A BODILY INJURY

AND PROPERTY DAMAGE:

Actions Or Activities Of PEO Worker

“Bodily injury” or “property damage” arising from the actions or activities of any “PEO worker”.

Professional Services Exclusion

"Bodily injury" or "property damage" due to the rendering of or failure to render any professional service. This exclusion does not apply to your liability for "bodily injury" or "property damage" arising out of your "employee's" providing or failing to provide professional health care services to another of your "employees", but no "employee" is an insured for his or her providing or failure to provide such professional health care services.

Wrongful Acts

“Bodily injury” or “property damage” arising from a wrongful act in the rendering or failure to render services to or for your client.

For the purposes of this exclusion, wrongful act shall mean any actual or alleged act, error, or omission, misstatement, or misleading statement in the course of providing “staffing services” to your clients by you or by any person for whose acts you are legally responsible.

SECTION I – COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY

COVERAGE is amended as follows:

1. Exclusion k. does not apply.

2. Exclusions a., b., e., f., g., h., i., l., and p. do not apply to any insured who did not personally acquiesce in or remain passive after having personal knowledge of such conduct. Our obligation to pay shall begin once the full extent of the assets of the responsible insured has been exhausted and once the Deductible as shown in the Declarations of the policy has been satisfied.

3. The following exclusions are added to Paragraph 2. Exclusions:

Actions Or Activities Of PEO Worker

“Personal and advertising injury” arising from the actions or activities of any “PEO worker”.

Professional Services Exclusion

"Personal and advertising injury" due to the rendering of or failure to render any professional service.

Wrongful Acts

“Personal and advertising injury” arising from a wrongful act in the rendering or failure to render services to or for your client.

For the purposes of this exclusion, wrongful act shall mean any actual or alleged act, error, or omission, misstatement, or misleading statement in the course of providing “staffing services” to your clients by you or by any person for whose acts you are legally responsible.

S. Staffing Services Definitions

1. SECTION V – DEFINITIONS, Paragraph 5. is revised to read:

“Employee” includes but is not limited to a “leased worker” and a “staffing service employee”.

“Employee” does not include a “temporary worker” or a “PEO worker”.

2. The following definitions are added to SECTION V – DEFINITIONS:

a. “PEO service” means staffing related services as a Professional Employer Organization

(PEO) you provide to your clients and to “PEO workers” in connection with employment of such workers.

b. “PEO worker” means a person you lease to your client under a written "PEO service" agreement or contract.

c. “Staffing Services” means services provided by a staffing company to their clients including but not limited to:

(1) Fulfillment of any of the administrative functions which would otherwise be normally fulfilled by an employer’s human resource function;

(2) Staffing related administrative services provided by an Administrative Services Organization (ASO);

(3) “PEO service”;

(4) Staffing related services provided to your clients for the recruitment, selection and placement of a person for employment with a client.

(5) Temporary, contingent or contract placement services;

(6) Vendor Management Service (VMS), means the facilitation, purchase and management of “staffing services” for clients including the placement and fulfillment of orders for “staffing service employees”;

(7) Services performed on behalf of your client by a “staffing service employee” who is not a direct hire or permanent placement;

(8) Services performed for a client company to supply that client company with a “staffing service employee”.

d. "Staffing service employee" means a person who is furnished by you to your client to perform the duties to which you have agreed.

PI-CANXAICH-002 (05/11)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR

CERTIFICATE HOLDER

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PROFESSIONAL LIABILITY COVERAGE PART

COMMERCIAL CRIME COVERAGE PART

COMMERCIAL INLAND MARINE COVERAGE PART

COMMERCIAL PROPERTY COVERAGE PART

COMMERCIAL AUTOMOBILE COVERAGE PART

SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS

AI or CH Additional Insured or Certificate Holder Address CH & AI Any person or organization with whom you have agreed to provide 30 days prior written notice of cancellation as provided by your insurance broker of such person or organization and that list is provided to us prior to any such cancellation

Various

The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part:

A. In the event we cancel the policy in accordance with the policy’s terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives.

1. 30 days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium.

As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT_WC 00 03 13_04/84

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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

State Description OR Any person or organization with whom the insured agrees to waive subrogation in a written contract.

WV Any person or organization with whom the insured agrees to waive subrogation in a written contract.

AZ Any person or organization with whom the insured agrees to waive subrogation in a written contract.

GA Any person or organization with whom the insured agrees to waive subrogation in a written contract.

MI Any person or organization with whom the insured agrees to waive subrogation in a written contract.

NC Any person or organization with whom the insured agrees to waive subrogation in a written contract.

NV Any person or organization with whom the insured agrees to waive subrogation in a written contract.

OK Any person or organization with whom the insured agrees to waive subrogation in a written contract.

TX Any person or organization with whom the insured agrees to waive subrogation in a written contract.

AR Any person or organization with whom the insured agrees to waive subrogation in a written contract.

FL Any person or organization with whom the insured agrees to waive subrogation in a written contract.

MD Any person or organization with whom the insured agrees to waive subrogation in a written contract.

MN Any person or organization with whom the insured agrees to waive subrogation in a written contract.

NM Any person or organization with whom the insured agrees to waive subrogation in a written contract.

NY Any person or organization with whom the insured agrees to waive subrogation in a written contract.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WC 00 03 13

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 04/16/2025 Policy No. KRM698158054 Endorsement No. 0

Insured Tryfacta Inc Premium $5,445

Insurance Company Carolina Casualty Insurance Company

Countersigned by

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT – BLANKET

- CALIFORNIA

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 for which you perform work under a written contract that requires you to obtain this agreement from us.

The premium charge for this endorsement shall be 2% of the Worker's Compensation premium, subject to a minimum premium charge of $500.

WC 99 07 00 A 1 of 1 (Ed. 04-19)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective 04/16/2025 Policy No. KRM403168306 Endorsement No. 0

Insured Tryfacta Inc Premium $192,027

Insurance Company StarNet Insurance Company

Countersigned by

Authorized Representative

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 07 00 A

(Ed. 04-19)