HomeMy WebLinkAbout310036 BLUE DOT SOLUTIONS INC - INSURANCE CERTIFICATE (9)ACORD �. a
ps DATE (MMIDDIYY)
06/14/2004
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 -
COMPANY
NEW HAMPSHIRE INSURANCE COMPANY
A
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
P
73
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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 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDNY) DATE (MMIDDmr) LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
$
COMMERCIAL GENERAL LIABILITY
PRODUCTS - COMP/OP AGG
$
CLAIMS MADE OCCUR
PERSONAL B ADV INJURY
�$
OWNER'S &CONTRACTOR'S PROT
I
EACH OCCURRENCE
$
FIRE DAMAGE (Any one fire)
$
MED EXP (Any one Person)
$
AUTOMOBILE
LIABILITY
ANY AUTO
INED SINGLE LIMIT
$
ALL OWNED AUTOS
TB
SCHEDULED AUTOS
Y INJURY
rson)
$
HIRED AUTOS
. -_-__-
- -- ---
NON -OWNED AUTOS
BODILY rr accident)
$
-----__-- -- ---
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
LIABILITY
_EXCESS
EACH OCCURRENCE
$
UMBRELLA FORM
AGGREGATE
$
OTHER THAN UMBRELLA FORM
$
WORKER'S COMPENSATION AND RMWC 2890256 (CO)
06/30/2004
07/01/2005
X _ ORVLA1Z; S J ER
EMPLOYERS' LIABILITY
$ 1,000,000
EL EACH ACCIDENT
THE PROPRIETOR/
PARTNERS/EXECUTIVE INCL
_-..___.
EL DISEASE - POLICY LIMIT
- _— _. ___-__
$ 11000,000
OFFICERS ARE: EXCL
$ 1,000,000
EL DISEASE - EA EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL 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.
WEST
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 NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
PURCHASING DEPARTMENT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLIGATION ORLIABILITY
P. 0. BOX 580
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
FT. COLLINS, CO 80522
AUTH D REPRESENTATIVE