HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATEACORD p J
,-� I��i�`E_
DATE (MMIDDlYY)
—
s 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
1001 BRICKELL BAY DRIVE,
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SUITE #1100
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MIAMI, FL 33131-4937
COMPANIES AFFORDING COVERAGE
800-743-8130
-- -
COMPANY AMERICAN HOME ASSURANCE COMPANY
A
INSURED
-
COMPANY
ADPTOTALSOURCE, 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
CO
L TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD YY) DATE (MMlDD YY) LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
$
COMMERCIAL GENERAL LIABILITY
PRODUCTS - COMPIOP AGG
$
CLAIMS MADE n OCCUR
PERSONAL & ADV INJURY
$
EACH OCCURRENCE
$
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Anyone fire)
$
MED EXP (Any one person)
$
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
$
ALL OWNED AUTOS
-
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON-OWNEDAUTOS
BODILY
acciident)RY
$
PROPERTYDAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
UMBRELLA FORM
AGGREGATE
$
OTHER THAN UMBRELLA FORM
$
WORKER'S COMPENSATION AND
RMWC 3476330
06i3012003
06/30/2004
X RYLAIW
A
EMPLOYERS' LIABILITY
EL EACH ACCIDENT
$ 1,000,000
THE PROPRIETOR/ INCL
PARTNERWEXECUTNE
EL DISEASE - POLICY LIMIT
$ 1,000,000
OFFICERS ARE: EXCL
EL DISEASE - EA EMPLOYEE
1 $ 1,000,000
OTHER
DESCRIPTION OF OPERATONSILOCATONSNEHICLES/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 CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY.
MST
iC
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. O. BOX 580
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
FT. COLLINS, CO 80522
AUTHgRlTED REPRESENTATIVE