HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (4)—a1 o
A`orsn CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDM')
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
AGO Risk Services. Inc of Florida
1001 Brickell Bay Drive, Suite 01100
CONTACT Aon Risk Services, Inc of Florida
NAME:
AHCONE No. Ext : 800-743-8130
(A/C, No : 800-522-751
E-MAIL
ADP.COLCenter@Aon.com
ADDRESS:
Miami, FL 33131-4937
PRODUCER 10762287
CUSTOMER ID#:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: NEW Hampshire Ins Cc
23841
ADP TotalSource I, Inc.
10200 Sunset Drive
INSURER B:
INSURER C:
Miami, FL 33173
ALTERNATE EMPLOYER
INSURER D:
National Research Center Inc
INsuRER e
3005 30th Street.
INSURER F'
Boulder, CO 80301 -
COVERAGES CERTIFICATE NUMBER: 320041 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 REQUES-1'ELL
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WEPOLICY
NUMBER
POLICYEFFECTIVE
DATE IMMIDDIYYYY)
POLICY EXPIRATION
DATE IMMIDDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
❑ COMMERCIAL GENERAL LIABILITY
❑ CLAIMS MADE' ❑ OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP(My one person)
$
PERSONAL& ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMPIOP AGG
$
❑ POLICY , 0 PROJECT ❑ LOC
$
AUTOMOBILE LIABILITY
D MY AUTO
COMBINED SINGLE LIMIT
E. accident)
$
BODILY INJURY
(Per person)
$
❑ALL OWNED AUTOS
❑ SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
❑ HIRED AUTOS
❑ NON OWNED AUTOS
-
PRO PERTV DAMAGE
(Per accident)$
❑ UMBRELLALIAe UCCUR
EACH OCCURRENCE
J
p.'EXCESS LIAB CLAJMSMADE
AGGREGATE
$
❑ DEDUCTIBLE
$
❑ RETENTION E
$
A
WORKERS' COMPENSATION AND
EMPLOYERS' LIABILITY
WC012437064CO
07/01/11
07/01/12
X I We sTArn OTHER
TORY uMITS
EL" EACH ACCIDENT
$ 2,000,000
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED'
NIA
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
IMmdalo,yin NH)
If Yes. Besu,Ee uMer
DESCRIPTION OF OPERATIONS tNi
E.L. DISEASE -POLICY LIMIT
$ 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
All Woftite employees mr-king 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 '
CANCELLATIONS "-
CITY OF FORT COLLINS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
ATTN: KELLY DIMARTINO
THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
P"O. BOX 580
AUTHORIZED REPRESENTATIVE
FT. COLLINS, CO 80522
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