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Home My WebLink AboutADP TOTALSOURCE CO XXI INC - INSURANCE CERTIFICATE (8)CERTIFICATE OF LIABILITY INSURANCE I y^ 05/15/20 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 endorsement(s). Am Risk Services, Inc of Florida 1001 Bdckell Bay Drive, Suite #1100 Miami, 331314937 AOP TotalSource CO XXI, Inc. 10200 Sunset Drive Miami, FL 33173 ALTERNATE EMPLOYER INSURER B : INSURER C :. INSURER E : INSURER F NAIL # THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND.CONDITIONS.OF.SUCHROLICIES. LIMITS.S BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOLICYPERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, HOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SP-0k0VN ARE A;: RFOUE STE D NSR L TYPE OF INSURANCEiNSR ADDL SUER WVD POUCYNUMBER POLICY EFF MMIODNYYY). POLICY EXP (MINDONYM LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH. OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT DLOC OTHER .GENERAL AGGREGATE $. PRO DUCTS, COMP/OP AGG $ AUTOMOBILE uABiLrrV ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per erson $ BODILY INJURY Per accident) - $ PROPERTY DAMAGE Per accident $. UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION- AND EMPLOYERS' LIABILITY YIN. ANY PROPRIETORIPARTNERIEXECUTNE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, demribe under DESCRIPTION OF OPERATIONS below 14 / A WC 027115056 CO 7/1/2010 7/1/2021 X PER STATUTE 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 I LOCATIONS I VEHICLES (ACORD 101, Additional All worksite employees working for HINES INC, paid under ADP TOTALSOURCE, Remarks Schedule, may be attached If more space Is required) INC.'s payroll, are covered under the above stated policy. HINES INC is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS 215 NORTH MASSONNSTREET STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FORT COLLINS, CO 80524 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �OIi �� Etf�iiEe3 � Q .:riT t04L�_L W 1958-2075 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD n me and logo are registered marks of ACORD K 000186 90005826100 6 02 02 0 0000 0 000 1077196