HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - 2004 INSURANCE CERTIFICATEDATE (MMIDDIYY)
ACORDN � xv
� .. � � _ 01/26/2004
PRODUCER Serial # A15188 THIS CERTIFICATE IS ISSUED AS A�MATTER OF INFORMATION
AON RISK SERVICES, INC. OF FLORIDA
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1001 BRICKELL BAY DRIVE, SUITE #1100
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MIAMI, FL 33131-4937
COMPANIES AFFORDING COVERAGE
800-743-8130
- - - -
coMPANv A AMERICAN HOME ASSURANCE COMPANY
INSURED
COMPANY
ADP TOTALSOURCE, INC.
B
10200 SUNSET DRIVE
— — _—
MIAMI, FL 33173 COMPANY
*ALTERNATE EMPLOYER: SNELLER ASSOCIATES, INC. C
DBA BLUE DOT SOLUTIONS INC.
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 CONTRACT OR 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 ALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Lco TYPE OF INSURANCE POLICY NUMBER P ATE (MMIDD/VYE POLICY
DATE M DDIYY EXPIRATION LIMITS
LTR ( ) ( 1
GENERAL
LIABILITY
_
GENERAL AGGREGATE 1$
PRODUCTS - COMPIOP AGG
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE � OCCUR
PERSONAL & ADV INJURY
$
EACH OCCURRENCE
$
OWNER'S & CONTRACTOR'S PROT
FIREDAMAGE (Anyonefire)
$
MED EXP (Arty one person)
_$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILv MJURY
(Per
$
HIREDAUTOS
NON -OWNED AUTOS
,
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY-EAACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
_$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
_
$
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND
RMWC 3476330
06i30/2003
06130/2004
RYU S OTa
A
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
$ 1,000,000
THE PROPRIETOR/ INCL
PARTNERSEXECUTNE
OFFICERS ARE EXCL
EL DISEASE -POLICY LIMIT
$ 1,000,000
- --
EL DISEASE - EA EMPLOYEE $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
ALL EMPLOYEES WORKING FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTAL SOURCE, INC'S PAYROLL, WILL BE COVERED
UNDER THE ABOVE STATED POLICY. *THE ABOVE NAMED
WEST
CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF FORT COLLINS
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
ATTN: JIM HUME
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
PURCHASING DEPARTMENT
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P. 0. BOX 580
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
FT. COLLINS, CO 80522
AUTH D REPRESENTATIVE