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HomeMy WebLinkAboutADP TOTALSOURCE DE IV INC - INSURANCE CERTIFICATEA � j �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMNDYYYY) 08/13/14 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 Saaces, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE I FM AID No Ext:800-743-8130 AlC No: 800-522-7514 1001 Bncims Bay Drive, Suite 41100 Miami, FL 331314937 ADDRESS: ADP.COI.Centef Aon.Com INSURERIS) AFFORDING COVERAGE NAICN INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSoume DE M, Inc. INSURER B : INSURER C : 10200 Sunset Cnv Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: INSURER E Texas Scenic Cc Inc 5423 Jackwcod, INSURER F San Antonio, TX 78238 COVERAGES CERTIFICATE NUMBER: 820788 - 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 MO POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSWADE 0 OCCUR EACH OCCURRENCE $ DAMAGETO RENTED PREMISES Eaoccunenca $ MED EXP (Any onePerson) $ PERSONAL 8 ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE POUCY LIMIT APPLIES PER. PROJECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COMBINED Ea accident LE LIMIT— $ BODILY INJURY Per on $ BODILY INJURY Peraccident $ ER A E Par accident $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMSAIADE EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION - ANDEMPLOYERTUABIUTY YIN ANY PROPRIETORrPARTNERIFXECUTIVE' ❑ OFFICER/MEMBER EXCLUDED? (Myer. mnNH) urn.DESCRIPTION OF OPERATIONS below N I A WC 094179822 TX 7/1/2014 7/1/2015 X WC STATU- TORYLIMITS 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 specs is required) All wolksim employees working for the aboxe named client cornpany, paid under ADP TOTALSOURCE, INC's payroll, are c xere l under the above stated policy. The above nomad client is an alternate employer under this policy. RE: Fort Collin Lincoln Center CERTIFICATE HOLDER CANCELLATION City of Fort Collins , Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 280 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. " AUTHORIZED REPRESENTATIVE of oil dvk cletvieeb, 4ae o f (floti& ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD