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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (9)A� O® CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYVY) G7/30/12 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 endorsement(s). PRODUCER Ash Risk Services, Inc of Florida 1001 Cricket Bay Drive, Suite #1100 Miami, FL 33131a93] CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX AIC, No, Ext: 800-743-8130 WC, No: 800-522-7514 EMAIL ADDRESS: ADP.COI.Cenler@Aortcom INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Ins Cc 23841 INSURED ALP TotalSource MI X , Inc. INSURER B INSURER C 102M Sunset Orive Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: INSURER E FRESCO Electric. Inc 7230 W 118th Place. Unit C INSURER F Broomfield CO 80020 COVERAGES CERTIFICATE NUMBER: 503040 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 ADEL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYVYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 11 OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence S MED EXP Ary one demorl $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 1-1 POLICY 0PROJECT F I LOC PRODUCTS - COMP/OP AGO $ $ 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) $ PR PERTV OAMA E Per acutlent 8 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYER$' LIABILITY YIN ANY PROPRIETORIPARTNERIEXEC FTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION DOF OPERATIONS below N / A WC 038087762 CO 07/14/42 07/01/13 X WCSTATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 2.000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 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 TOTALSOURCE. INC is 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 PO Be. 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522-0580 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0gon �:,k &tvicee, 4nc o � flotida ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD