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HomeMy WebLinkAboutADP TOTALSOURCE CO XXI INC - INSURANCE CERTIFICATE (3)1 @3 ACC)R© CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) os/osn s 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 have ADDITIONAL INSURED provisions or 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 33131-4937 CONTACT Aon Risk Services, Inc of Florida NAME: (A/C,PHONo 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 I, Inc. INSURER B : 10200 Sunset Drive INSURER C INSURER D : Miami, FL 33173 ALTERNATE EMPLOYER INSURER E : National Research Center Inc 2955 Valmont Road, Suite 300 II Boulder, CO 80301 INSURER F : COVERAGES CERTIFICATE NUMBER: 2319251 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. UN41TS ;:H0',NN ARE AS R;:OUEST•�D INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ POLICY ❑ PROJECT LOC OTHER AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT accident) $ BODILY INJURY Per erson $ ANY AUTO BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEC I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N XI PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 A ANY PROP RIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) WC 080371929 CO 7/1/2019 7/1/2020 E.L. DISEASE • EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT I $ 2,000,000 It yes, describe OF OPERATIONS below under DESCRIPTION DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) All worksite employees working for NATIONAL RESEARCH CENTER INC, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. NATIONAL RESEARCH CENTER INC is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS City Hall West 300 Laporte Avenue Fort Collins, CO 80522 ACORD 25 (2016/03) 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 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m 000760 90002897900 4 02 02 0 0000 0 000 1100781