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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (2)ACORDDATE li !T CERTIFICATE OF LIABILITY (MMIDD/YY) _.,,., 06/25/2008 PRODUCER Serial # A16271 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 PHONE: 800-743-8130 FAX: 800-522.7514 __-- -- --- ---- ----- ----__ .....____ COMPANY NEW HAMPSHIRE INSURANCE COMPANY A INSURED ....- .....___ __. ___. COMPANY ADP TOTALSOURCE, INC. B 10200 SUNSET DRIVE --- --- --- --- ---- MIAMI, FL 33173 COMPANY "ALTERNATE EMPLOYER: C BLUE DOT SOLUTIONS INC. COMPANY D COVERAGES - — 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION LIMITS LTR DATE (MM/DDIYY) DATE (MMIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS -COMP/OP AGG $ CLAIMS MADE I OCCUR PERSONAL & ADV INJURY $ OWNER'S B CONTRACTOR'S PROT EACH OCCURRENCE $ —� FIRE DAMAGE (Any one lire) $ MGD EXP (Anyone person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMI I $ ALL OWNED AUTOS (BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS -—- ---- BODILY INJURY $ NON -OWNED AUTOS For accident) __--- __-- -- PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACI I OCCURRENCE $ UMBRELLA FORM accaecnTE $ OTHER THAN UMBRELLA FORMAT g WORKER'S COMPENSATION AND WC 5881064 CO 07/01/2008 07/01/2009 OTH- X ITOFY LIIMIUTS ER A EMPLOYERS'LIABILITY ELEACHACCIDEN'I $ 1,000000 THE PROPRIETOR/ IINCL EL DISEASE -POLICY LIMIT $ 1,OOD000 PARTNERSIEXECUTIVE __ -- OFFICERSARE: �EXCL EL DISEASE, EA EMPLOYEE $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS AI_I_ EMPLOYEES WORKING FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTALSOURCE, INC.'S PAYROLL, WILL BE COVERED UNDER THE ABOVE STATED POLICY.'THE ABOVE NAMED CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE AON RISK SERVICES, INC. OF FLORIDA ACORD 25-S (1195) ' - ©ACORD'CORPORATION 1988-' ACORD CERTIFICATE'OF LIABILITY DATE (MMIDDIYY) INSURANCE 06/25/2008 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 PHONE: 800-743-8130 FAX: 800-522-7514 ....__ _. COMPANY NEW HAMPSHIRE INSURANCE COMPANY A INSURED COMPANY ADP I OTALSOURCE, INC. B 10200 SUNSET DRIVE ----- ---- ---— ------ MIAMI, FL 33173 COMPANY *ALTERNATE EMPLOYER: C BLUE DOT SOLUTIONS INC. COMPANY -- D COVERAGES - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN fSSUED 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. L R ( TYPE OF INSURANCE POLICY NUMBER l POLICY EFFECTIVE POLICY EXPIRATION DATE(MMIDDIYY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS AGO CLAIMS MADE I OCCUR -COMP/OP 5 PERSONAL &ADV INJURY $ OWNER'S &CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MEDEXP (Anyone person) $ AUTOMOBILE LIABILITY ANYAUTO COMBINEDSINGLE LIMIT $ ALL OWNED AUTOS BODILYINJURY $ SCHEDULED AUTOS (Perrperson) HIRED AUTOS- ___----- (Pe,eccid.pF) $ NON-OWNEDAUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EAACCIDENT 5 ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCEUMBRELLA $ FORM _ AGGREGATE 5 OTHER THAN UMBRELLA FORM - -----_- WORKER'S COMPENSATION AND W C 5881064 CO 07/01 /2008 07/01 /2009 X oari mils ° H A i EMPLOYERS' LIABILITY F.I.EACH ACCIDFM I $ 1:000,000 THEPROPRIET°W INCL aAaTNEaS/EXf.CUTWE __.. EL DISEASE -POLICY LIMIT Is $ 1,OOD,000 OFIICERS AaE: EXCL EL DISEASE -EA EMPLOYEE 1,000,000- I OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS ALL EMPLOYEES WORKING FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTALSOURCE, INC'S PAYROLL, WILL BE COVERED UNDER THE ABOVE STATED POLICY.*THE ABOVE NAMED CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY. CERTIFICATE HOLDER ....CANCELLATION 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 AUTHORIZED REPRESENTATIVE AON RISK SERVICES, INC. OF FLORIDA ACORD 25-S'(1195) < ©ACORD-CORPORATION 1988 i.