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HomeMy WebLinkAboutPROPERTY ROOM - INSURANCE CERTIFICATE (13)A 1Y CERTIFICATE OF LIABILITY INSURANCE DATEIM06/14/134/13YYY) 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 Aon Risk Services, Inc of Florida CONTACT NAME: ADD Risk Services, Inc of Florida PHONE I FAX No, Ext: 800-743-8130 JC No: 800-522-7514 1W1 Brickell Bay Drive, Suite N1100 Miami, FL 33131-4937INC, EMAIL ADDRESS: ADP.COI.Cenler ADn.com INSURER(S) AFFORDING COVERAGE NAIC p INSURER A : New Hampshire Ins Cc 23841 INSURED ACE TotalScurce FL XI, Inc. INSURER B : INSURER C : 10200 Sunset Drive Miami, FL 33173 INSUER RD: ALTERNATE EMPLOYER Sheller Associates, Inc. 19M Grant Street, suite 800 INSURER E INSURER F : - Denver, CO W203 COVERAGES CERTIFICATE NUMBER: 615485 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 ADOL INSR SUBR W E) POLICY NUMBER POLICY ERE MM/DDIVVYY POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1:1 OCCUR EACH OCCURRENCE $ DAMAGES( RENTED TO PREMISES RENTED ) $ MED EXP (Any one arson $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOD PRODUCTS - COMP/OP ADD $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT Ea $ BODILY INJURY Per personL $ BODILY INJURY Per accident $ PR UP _ER. DAMA E Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION$ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) 11 /as, d,v,mN r i,. DESCRIPTION OF OPERATIONS below NIA WC 015665231 CO _ 7/l/2013 7/1/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L.DISEASE -EA EMPLOYEEI $ 2,000.000 -- E.L. DISEASE - POLICY LIMIT I S 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All worksile 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 FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: JIM HUME THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PURCHASING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. R 0, BOX 580 FT. COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE p4on Disk Se cvicee, 2nc of (Rwada © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AI �® CERTIFICATE OF LIABILITY INSURANCE DATE /Y1'YY) O6/14/1/14/13 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 endorsement(s). PRODUCER Aon Risk Services, Inc of Florida CONTACT NAME: ADD Risk Services, Inc of Florida PHONE I FAX (AID,No EXt : 800-743-8130 JC, No): 800-522-7514 1001 cricket Bay Drive, Suite #1100 Miami, FL 33131-4937 EMAIL ADDRESS: ADP.COI.Center Aon.com INSURERS) AFFORDING COVERAGE NAIC If INSURER A: New Hampshire Ins Co 23841 INSURED ADP Total$ource FL XI, Inc. INSURER B: INSURER C 10200 Sunset Drive Miami, FL 33173 INSURERD: ALTERNATE EMPLOYER Sheller Associates, Inc. 1900 Grant Street, suite 800 INSURER E : INSURER F : Denver, CO 80203 COVERAGES CERTIFICATE NUMBER: 615486 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 SUER MD POLICY NUMBER POLICY BEE MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE1:1 OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ VIED EXP (Any oneperson) $ PERSONAL B ACV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. POLICY 7 PROJECT F LOC PRODUCTS - COMPIOP AGG IS $ 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) $ Pft PERTYDAMAGE Per accident S UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) u'. orsvae",ro.. DESCRIPTION OF OPERATIONS below N I A WC 015685231 CO 7/1/2013 7/112014 X WC STATU- TORV LR41TS OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEEI $ 2.000,000 E.L. DISEASE - POLICY LIMIT 1 $ 2.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All workeite employees working for the above named client company, paid under AGE TOTALSOU RC E, 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 FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: JIM HUME THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PURCHASING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. P. O. BOX 580 FT. COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE c4on i de tvicee, 2nc o f tfloaida © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A� �® CERTIFICATE OF LIABILITY INSURANCE Dnr06/14/13 O6/14/13 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 Bnckell Bay Drive, Suite #1100 Miami, FL 33131>937 CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX A/C No Ext: 800-743-8130 A/C No: 800-522-7514 ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: Nev, Hampshire Ins Co 23841 INSURED ADP Totalsource I, Inc. INSURER B : INSURER C : 102M Sunset Drive Miami, FL33173 ALTERNATE EMPLOYER INSURER D INSURER E National Research Center Inc 2955 Valmont Road. Suite 300 INSURER F Boulder. CO 80301 COVERAGES CERTIFICATE NUMBER: 622434 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 VIVID POLICY NUMBER POLICY EFF MMMD/YYYY POLICY EXP MWDDNYYY LIMBS " GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 171 OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea oxurrence $ MED EXP (My oneperson) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOG PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COM61NED SINGLE LIMIT Ea acoitlent $ BODILY INJURY Perperson) $ BODILY INJU RY Peraccidenl $ PR P R A Per accident $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORrPARTNEFWXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yaa, d.. uwe, DESCRIPTION OF OPERATIONS below NIA WC 015685231 CO 7/1/2013 7/1/2014 X STATU- TWOCRY LIMITS TH- OER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All woBsite employees working for the above named client company, paid under ADP TOTALSOURCE, INCJs payroll, are covered under the above staled 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 City Hall West THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 Laporte Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE �ioa"�is�C $etvicee, Qiec o f �f�otida ACORD 25 (2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® `� CERTIFICATE OF LIABILITY INSURANCE DATE IMWDDNYYYI 1 06114/13 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 Ronda 1001 Bdckell Bay Drive, Suite N1100 Miami, FL 33131-493] CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX AIC No Est): 800-743 8130 AIC No): 800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: New Hampshire Ins Cc 23841 INSURED ADP TotalSource 1, Inc. INSURER B: INSURER C 10200 Sunset Drive Miami, FL 33173 INSURER D : ALTERNATE EMPLOYER INSURER E National Research Center Inc 2955 Valmont Road. Suite 300 INSURER F Boulder, CO 80301 IKtl'I:l:T_Cei 013:411liLoL•llqtzlrlul ,-- 'ia•/67Lol'IULr1ut.J 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 SUER WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDNYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Eaomunence $ MED EXP (Any oneperson) $ PERSONAL S AOV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE POLICY LIMIT APPLIES PER. PROJECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS H COMBINED IN LE LIMIT Eff.ccident $ BODILY INJURY Per arson $ BODILY INJURY Per accident $ R PERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAR L OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICEfLMEMBER EXCLUDED' (Mandatory In NH) e ym, d. ua um., DESCRIPTION OF OPERATIONS bean NIA WC 015685231 CO 7/l/2013 7/1/2014 I WC STATU- ITORYLIMITSI OTH- I ER E.L. EACH ACCIDENT 8 2,000,000 E.L. DISEASE- EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I 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 polity. CERTIFICATE HOLDER CANCELLATION City of Fort Collins City Hall West 300 Laporte Avenue Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (Aon cki:ih $etrlam" Qnc o f(7F&td- 6 ©1988-2010 ACORD CORPORATION. All riahtc ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AOICC>Riff CERTIFICATE OF LIABILITY INSURANCE D 061141DIYYYY) O6/14/13 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 endorsement(s). PRODUCER Ain Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX AIC No Ext: 800-743-8130 IN No: 800-522-7614 1001 fmc,ell Bay Drive, Suite #1100 Miami, FL 33131-093] EMAIL ADDRESS: ADP.COLCeOter On.COm INSURER(S) AFFORDING COVERAGE NAICA INSURER A: New Hampshire Ins Cc 23841 INSURED ADP Tolas.urce MI XXX, Inc. INSURER B INSURER C : 10200 Sunset Drive Miami, FL 33113 INSURER D ALTERNATE EMPLOYER Bishop-Brogden Associates, Inc. 333 W. Hampden Ave., Suite 1050 INSURER E INSURER F: Englewood CO a0110 COVERAGES CERTIFICATE NUMBER: 651219 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 SUER MD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR EACH OCCURRENCE S DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any oneperson) $ PERSONAL B AOV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER. POLIGYF7PROJECTF—I LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Ea acci D IN LE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per acciden0 $ PROPERTY DAMAGE Per accident $ 8 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S OEC RETENTIONS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEPoXECUTIVE ❑ OFFICERIMEMBER EXCLUDED' (Mandatory in NH) It yesniwcfIoe eoeer DESCRIPTION OF OPERATIONS Valuw N I A WC 015685231 CO 7/l/2013 .711/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT _ 8 2.000.000 EL DISEASE EA EMPLOYEE $ 2.000.000 E.L. DISEASE - POLICY L'Mli 1 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 Fort Collins - Purchasing P.O. Box 580 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 p4o/z oiek rfezvicee, 2ite of (flo till ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD `' �® DATE CERTIFICATE OF LIABILITY INSURANCE 06/14/13 (MYYY) 4/13 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 endorsement(s). PRODUCER Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 CONTACT NAME: Aon Risk Services, Inc of Flonda PHONE FAX A/C No Eat): 800-743-8130 1 INC,No): 800-522-7514 EMAIL ADDRESS: ADP.COI.Cenlef on.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 FRESCO Electric, Inc 7230 W 118th Place„ Unit C _ INSURER F : Broomfield GO 80020 COVERAGES CERTIFICATE NUMBER: 645744 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 SUER MD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES RENTED $ IVIED EXP (Any oneperson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER: PROJECT LOG PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NONOWNEDPR HIRED AUTOS AUTOS H MBINEO SINGLE LIMI Ea BIKED $ BODILY INJURY Perperson) $ BODILY INJURY (Per accident) $ PERTY DAMAGE Per accident $ $ UMBRELLA LIAR EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ IAGGREGATE $ DEC I i RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED' (Mandatory in NH) Ifyes.0escrl iirrsr DESCRIPTION OF OPERATIONS below NIA WC 015685231 CO 7/l/2013 7/1/2014 X I WC STATU- TICLIMITS 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 / 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 Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522-0580 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0401t ci6ASeavicee, 2nc o f cflo cida ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved: The ACORD name and logo are registered marks of ACORD