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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (12)ACORa Ill CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) D,/i4/13 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 Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite#1100 Miami, FL 331314937 CONTACT NAME: Aon Risk Services. Inc of Florida PHONE FAX INC, No Ext: 800-743-8130 A/C No: 800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : New Hampshire Ins Co 23841 INSURED ADP TotalSource MI XXX, Inc. INSURER B : INSURER C 10200 Sunset Drive Miami, FL 33173 INSURER D: ALTERNATE EMPLOYER INSURER E Bishop Brogden Associates Inc 333 W. Hampden Ave. Suite 1050 INSURER F Englewood, CO 80110 COVERAGES CERTIFICATE NUMBER: 536214 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 WVO POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMMOM'YY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (My oneperson) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC PRODUCTS - COMP/OP ASS $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident S BODILY INJURY Per erson $ BODILY INJURY Per accident $ PR PERTV DAMA Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORrPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) u ym. dmcnus uri DESCRIPTION OF OPERATIONS below NIA WC 038087762 CO 12/08/12 07/01/13 X WC STATU- TORY HMITS OTH- ER E. L. EACH ACCIDENT$ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT S 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 Pon Collins - Purchasing SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE cgon oIsk <jeavicee, Qne o (flo cida ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD