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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (6)DATE (MM/DD/YY) Ai "g CERTIFICATE OF LIABILITY INSURANCE Certificate D10184064 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Aon Risk Services, Inc. of FL CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1001 Brickell Bay Drive, Suite #1100 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami, FL 33131-4937 INSURERS AFFORDING COVERAGE NAIC # Phone: 800-743-8130 Fax: 800-522-7514 INSURED INSURER A: New Hampshire Ins Co 23841 ADP TotalSource FL XI, Inc. INSURER B: 10200 Sunset Drive INSURER C: Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: Blue Dot Solutions, Inc. INSURER E:. 1900 Grant Street suite 1200 Denver, CO 80203 .ry COERAGES�a �f 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ❑ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES ❑ CLAIMS MADE ❑OCCUR (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ ❑ POLICY ❑PROJECT ❑ LOC PRODUCTS — COMP/OP AGG $ $ ❑ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) $ ❑ ALL OWNED AUTOS BODILY INJURY $ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS (Per person) ❑ NON OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ - (Per accident) GARAGE LIABILITY AUTO ONLY— EA ACCIDENT $ ❑ ANY AUTO EA OTHER THAN ACC $ AUTO ONLY: $ AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE $ ❑DEDUCTIBLE $ - $ ❑RETENTION _ $ WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY OTHER ElTORY A YIN WC058339956C0 07/01/10 07/01/11 LIMITS ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ $2,000,000 (Mandatory in NH) E.L. DISEASE — EA EMPLOYEE $ $2,000,000 If Yes, describe under E.L. DISEASE — POLICY LIMIT $ $2,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS All worksite employees working for the above named client company, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. The above named client is an alternate employer under this policy. .� CERTIFICATE I DER a h CANCELLATION ,_ .:____ .:. r : CITY OF FORT COLLINS ..__s__... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ATTN: JIM HUME ; , THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE PURCHASING DEPARTMENT CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION P. O. BOX 580 '?h OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. FT. COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE Illmo Oil Af A ftvLCG9, qnc. Of 01`7 AC0RD'25 (20U9/011 f f ©1988552009ACORD CORPORATIONAII rights r r serves ne M1 Urtv ndma dno logo are reglsiereo marKs Or Ak UKU DATE (MM/DD/YY) Q CERTIFICATE OF LIABILITY INSURANCE Certificate D10184065 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Aon Risk Services, Inc. of FL CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1001 Brickell Bay Drive, Suite #1100 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. .Miami, FL 33131-4937 INSURERS AFFORDING COVERAGE NAIC # Aone: 800-743-8130 Fax: 800-522-7514 INSURED INSURER A: New Hampshire Ins Cc 23841 ADP TotalSource FL XI, Inc. INSURER B: 10200 Sunset Drive INSURER C: Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: Blue Dot Solutions, Inc. INSURER E: 1900 Grant Street suite 1200 Denver, CO 80203 COVERAGES=' s a6 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YYYY) POLICY EXPIRATION DATE(MM/DD/YYYY) LIMITS ❑ GENERAL LIABILITY EACH OCCURRENCE $ ❑ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ❑ CLAIMS MADE ❑ OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ❑ POLICY ❑PROJECT ❑ LOC PRODUCTS — COMP/OP AGG $ $ ❑ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ D ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY $ ❑ SCHEDULED AUTOS ❑ HIRED AUTOS (Per person) - ❑ NON OWNED AUTOS BODILY INJURY (Per accident) - $ PROPERTY DAMAGE $ - (Per accident) GARAGE LIABILITY AUTO ONLY — EA ACCIDENT $ ❑ ANY AUTO EA $ OTHER THAN ACC AUTO ONLY: $ AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE $ ❑DEDUCTIBLE $ " ❑RETENTION $ WORKERS' COMPENSATION AND ® ❑ OTHER -s., '.,, -- A EMPLOYERS' LIABILITY YIN WC 058339956 CO 07/01/10 07/01/11 TO Y LIMITATU- TORY LIMITS ; ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ $2,000,000 (Mandatory in NH) E.L. DISEASE — EA EMPLOYEE $ $2,000,000 If Yes, describe under E.L. DISEASE — POLICY LIMIT $ $2,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS All worksite employees working for the above named client company, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. The above named client is an alternate employer under this policy. CERTIFICATE MOLDERS CANCELLATION'S T CITY OF FORT COLLINS "' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ATTN: JIM HUME ' THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE PURCHASING DEPARTMENT CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION P. O. BOX 580 OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. FT. COLLINS, CO 80522 = AUTHORIZED REPRESENTATIVE (#OR A3A ifevicei, q Re of (fl b 988 2009 ACORD CORPORATION AI1-hhii4iiserved. "ACORD 25t(2009/01) �� x �.�. e ._ 01 The ACORD name and Innn are reeistered marks of ACORD