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HomeMy WebLinkAboutADP TOTALSOURCE MI XXX INC - INSURANCE CERTIFICATEA� �® CERTIFICATE OF LIABILITY INSURANCE DAT01/09/14 , 01/09/t4 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 Bracken Bay Drive, Suite 01100 Miami, FL ell Sa <937 CONTACT NAME: Aon Risk Services, Inc Of Florida PRUNE I aG No Est : 800-743-8130 F No); 80"22.7514 ADDRESS: ADP.COI.Center(MAon.com INSURERS) AFFORDING COVERAGE RAICA INSURER A: New Hampshire Ins Co 23841 INSURED ADP TatalSou ce MI XXX, Inc. INSURER B INSURER C 102M Sunset Drive Miami, FL 33173 INSURER D ALTERNATE EMPLOYER INSURER E FRESCO Electric, Inc 7230 W 11 Bin Place„ Unit C INSURER F : Broomfield, CO 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 WVD POLICY NUMBER POLICY EFF MMIDDIYYYY PODCY EXP MM/D LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—IOCCUR EACH OCCURRENCE S DAMAGE TO RENTED PREMISES Esamrtatoe $ MED EXP (Any amperson) 3 PERSONAL & ADV INJURY $ GENERALAGGREGATE S GENT AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NONHIRED AUTOS AUTOS WNED Ea accident $ BODILY INJURY Per ereon $ BODILY INJURY Peraccident S Pm accidentA $ S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DEC I I RETENTION It A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory, In NH) If yes, desddbe weer DESCRIPTION OF OPERATIONS below N I A WC 015685231 CO 7/1/2013 12/14/2013 X WC STATU- 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 WORKERS' COMPENSATION & EMPLOYERS' LIABILITY COVERAGE FOR FRESCO Electric, Inc TERMINATED EFFECTIVE 12114/2013 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) All workete employees working for the above named client company, paid under ADP TOTALSOURCE. INC.'e 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 0 ioa oiak <Jetvicee, 4nc of CFLotida © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD