The URL can be used to link to this page

Home My WebLink About310036 BLUE DOT SOLUTIONS INC - INSURANCE CERTIFICATE (5)/1 o %`- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/W) 06/10111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ACT Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 CONTACT Aon Risk Services, Inc of Florida , NAME: A/CONE No. Ext : 800-743-8130 FAX A/C, No): . 800-522-751 Miami, FL 33131-4937 E-MAIL ADDRESS: ADP.COLCenler@Aon.com PRODUCER 10762287 CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: New Hampshire Ins Co2334t ADP TotalSource FL XI, Inc. 10200 Sunset Drive INSURERS: INSURER C: Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: Blue Dot Solutions, Inc. INSURER E: 1900 Grant Street, suite 1200 Denver, CO 80203 INSURER F: COVERAGES CERTIFICATE NUMBER: 298968 - REVISION NUMBER: 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 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. LIMITS SHOWN AREAS REQUESTED, INBR LTR TYPE OF INSURANCE ADDL INSR SUBR MD POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDNY ) POLICY EXPIRATION DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ O COMMERCIAL GENERAL LIABILITY ❑ CtA,IMS MADE ❑ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ VIED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ ❑ POLICY ❑ PROJECT ❑ LOC $ AUTOMOBILE LIABILITY ❑ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per accident) $ ❑ HIRED AUTOS ❑ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ --O UR!CnCLLALIAO OCCUR EA fI OC.CURNcNI:E S ❑ EXCESS LIAR CLAIMS -MADE AGGREGATE $ ❑ DEDUCTIBLE $ ❑ RETENTION E $ A WORKERS' COMPENSATION AND EMPLOYERS'LIABILITY WC 012437064 CO 07/01/11 07/01/12 x WC STATU- OTHER To YuMITS E.L. EACH ACCIDENT $ 2,000,000 ANYPROPMETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA — EA EMPLOYEE $ 2,000,000 hNWXo tin anELDISEASE B yes, dewibe Amer E.L. DISEASE —POLICY LIMIT $ 2,000.000 DESCRIPTION OF OPERATIONS eaaw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) 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 HOLDER - CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ATTNJIM HUME THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PURCHASING DEPARTMENT AUTHORIZED REPRESENTATIVE P.O. BOX 580 FT. COLLINS,, CO 80522 �OR �fdlrf ('�l2V[CGS, RRC O f (f�04[f�Q �1 o "ki CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/VY) 06/10/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ADD Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 CONTACT ADD Risk Services, Inc of Florida : - NAMEPHONE A/C No. Ent 800-743-8130 EX A/C. No): 800-522-751 Miami, FL 33131-4937 E-MAIL ADP.COLCenter@Aon.com ADDRESS: PRODUCER 10762287 CUSTOMERID#: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA. New Hampshire Ins Cc 23841 ADP TotalSource FL A, Inc. 10200 Sunset Drive INSURER IB INSURER C Miami, FL 33173 ALTERNATE EMPLOYER INSURERD Blue Dot Solutions, Inc. INSURER E. 1900 Grant Street, suite 1200 -Denver, CO 80203 INSURERF: ,- COVERAGES CERTIFICATE NUMBER: 298969 REVISION NUMBER: 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 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. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE ADDL INSR EUBR YND POLICY NUMBER POLICY EFFECTIVE DATE(MMIDOMTTY) POLICY EXPIRATION DATE (MM/DDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ❑ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE ❑ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence)$ MED EXP (Any one person) $ - PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS - COMP/OP AGG $ ❑ POLICY ❑PROJECT ❑ LOC $ AUTOMOBILE LIABILITY n ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per accident) $ ❑ HIRED AUTOS ❑ NON OWNED AUTOS - PROPERTY DAMAGE (Per accitlent) $ - ❑ UM^RELLA LL:o occur. EACHOCCURRENCE$ ❑ EXCESS UAB CLAIMS -MADE AGGREGATE $ ❑ DEDUCTIBLE $ ❑ RETENTION It $ A WORKERTCOMPENSATION AND EMPLOYERS' LIABILITY WC 012437064 CO 07/01/11 07/01/12 x WC BTATU- OTHER TORT uMITS E.L. EACH ACCIDENT $ 2,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICPROVENDER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ 2,000,000 IMa^mnory in NH) N ye3, tlyix,, ha undo, E.L. DISEASE -POLICY LIMIT $ 2,000.000 DESCRIPTION OF OPERATIONS bulow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 HOLDER CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ATTN: JIM HUME THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PURCHASING DEPARTMENT AUTHORIZED REPRESENTATIVE P.O.BOX 5S FT. COLLINS, CO 80522 �on�vk�eavice�, 2ncofCflotida