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Home My WebLink About488920 TEXAS SCENIC COMPANY INC - INSURANCE CERTIFICATE (2)Ae" b® ItI CERTIFICATE OF LIABILITY INSURANCE DATE IMruoonYYY) 06/14/12 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 endorsements . PRODUCER Ann Risk Services, Inc of Flonda 1001 Bnckell Bay Drive, Suite #1100 iami. MFL 33131-4937 CONTACT AOD Risk Services, Inc Of Florida NAME: PN N FAX Ext : 800-743-8130 AIC, No); 800-522-7514 AIC,EMAIL L ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC If INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSource DE IV, Inc. INSURER B INSURER C 10200 Sunset Drive Miam, FL 33173 ALTERNATE EMPLOYER INSURER D: INSURER E Texas Scenic Company Inc 5423 Jackwood, INSURER F San Antonio, TX 78238 COVERAGES CERTIFICATE NUMBER: 480250 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 SUBR MD POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS -MADE F—IOCCUR MED EXP JAny one setson $ PERSONALS ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ $ POLICY PROJECT LOC IN LE LIMIT AUTOMOBILE LIABILITY Ewa acccdent $ BODILY INJURY Perperson) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ NON -OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEC I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 2.000,000 ANY PROPRIETORIPARTNERIEXECUTIVE DFRCERIMEMBER EXCLUDED? NIA WC 038087787 TX 7/l/2012 7/1/2013 E.L. DISEASE - FA EMPLOYEE $ 2.000,000 (Mandatory, in NH) If yes. dev uMer E.L. DISEASE - POLICY LIMIT b 2,000.000 DESCRIPTION OF OPERA'I IONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All workshe 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. RE: Fort Collins Lincoln Center CERTIFICATE HOLDER CANCELLATION City of Fort Collins, Colorado PO Box 280 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 04orr. pPiek eexvici 21te of (:floxida 11988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD