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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (8)ACORa DATE( MMIDDIYYYY) �- CERTIFICATE OF LIABILITY INSURANCE O6/,4/,2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER."rTHIS- 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 Aon Risk Services. Inc of Florida 1001 Brickell Bay Drive. Suite 91100 Miami, FL 33131-0937INC, CONTACT NAME: Aon Risk Services, Inc of Florida PHONE I FAX No, Ext: 800-743-8130 JC, No: 800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSource I, Inc. INSURER B INSURER C 10200 Sunset Drive Miami, FL 33173 INSURER D UC/F INSURER E PROPERTYBUREAU Cam Inc. DBA Property Room 5257 Buckeystown Pike, Suite 475 INSURER F Frederick, MD 21704 COVERAGES CERTIFICATE NUMBER: 447116 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INS I )RED 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 ADEL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDD/YYVV POLICY EXP MM/DDIYYVY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES fEa occurrence) $ MED EXP An oneperson) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PROJECT LOC PRODUCTS - COMPIOP AGG S $ A AUTOMOBILE LIABILITY ANY AUTO ' ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERJEXECUTIVE OFRCERIMEMBER EXCLUDED? ElNIA (Mandmary in Nil) It ye,, dwxibv um., DESCRIPTION OF OPERATIONS below �WC 111095724 CA 7/112012' 7/l/2013 X TORY IMITS OER EL EACH ACCIDENT $ 2,000,000 cL DISEASE -EA EMPLOYEE $ 2.00D.eDD 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 worksite employees working for the above named client company, paid under ADP TOTAL SOURCE, INC's payroll, are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 North Mason Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (9`Fon.C?ZAA&cv1aiI gnaoftfloodi ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD