HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATEINSURED
ADP TOTALSOURCE, INC.
10200 SUNSET DRIVE
MIAMI, FL 33173
'ALTERNATE EMPLOYER:
BLUE DOT SOLUTIONS INC.
uRA+N/� DATE (MMIDDIYY)
E 06/11 /2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A NEW HAMPSHIRE INSURANCE COMPANY
COMPANY
B
COMPANY
C
COMPANY
D
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y 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.
T TYPE OF INSURANCE DA E(MMIDCDIYY) PDATE(MMIDDIYY)N LIMITS LTR POLICY NUMBER
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMSMADE OCCUR
COMMERCIAL
& CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
PERSONAL &ADV INJURY $
EACH OCCURRENCE $
FIREDAMAGE (Anyonefire) $
MED EXP (Anyone person) $
COMBINED SINGLE LIMIT Is
BODILY INJURY $
(Per person)
BODILVINJURY $
(Per accident)
PROPERTYDAMAGE Is
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACHACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
UMBRELLA FORM
AGGREGATE
$
OTHER THAN UMBRELLA FORM
W
A
WORKER'S COMPENSATION AND
EMPLOYERS'LIABILITY
THE PROPRIETOR/ WCL
PARTNERSIEXECUTME
WC 1106952 CO
07/01/2007
07/01/2008
X roevuilis °ER
EL EACH ACCIDENT
$ 1,000,000
EL DISEASE -POLICY LIMIT
$ 1,000,000
OFFICERS ARE: EXCL
OTHER
EL DISEASE -EA EMPLOYEE
$ 1,000,000
ALL EMPLOYEES WORKING FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTALSOURCE, INC.'S PAYROLL, WILL BE COVERED UNDER TH
ABOVE STATED POLICY. -THE ABOVE NAMED CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY.
�5T
CITY OF FORT COLLINS
ATTN: JIM HUME
PURCHASING DEPARTMENT
P. O. BOX 580
FT. COLLINS, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AON RISK SERVICES, INC. OF FLORIDA