HomeMy WebLinkAboutADP TOTALSOURCE CO XXI INC - INSURANCE CERTIFICATE (9).�►cvRn CERTIFICATE OF LIABILITY INSURANCE /2
05/1520.
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 WANED, subject to th 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 CONTACT
Am Risk SeMces,'Inc of Florida NAME: AOn Risk Services, Inc Of Florida
Miami,
FIL 33131-A937 l Bay Drive, Suite 01100 PHONE A/C, No Ext : 800-743-8130. A/C No : 800-522-7514.
Miami,, FL
NAIC e
mouncu
ADP TotalSource CO'XXI, Inc.
INSURER B:
INSURER C :
10200 Sunset Drive
Muni, FL 33173
ALTERNATE EMPLOYER
INSURER D :
INSURER E - - -
Team Electric, Inc.
1158 S Upan St,
INSURER F :
_
Denver, CO 80223
COVERAGES CERTIFICATEINUMBER:
2so2928 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM�OR
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
BELOW HAVEBEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE -POLICY PERIOD "
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS ;;HOhJPi ARE: A-0 REQUESTED
SR
LTR
TYPE OF INSURANCE
ADOL
INSR
SUBR
WVD
(POLICY NUMBER
POLICY EFF
MMIDO
POLICY EXP
MWDD
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MED EXP (Any one arson
$
PERSONAL 8 ADV INJURY.
$.
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
OTHER
GENERAL AGGREGATE
. $.
PRODUCTS-COMP/OP AGG
$
AUTOMOBILE
LIABILITY
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 LIAB.
OCCUR
CLAIMS -MADE - .
EACH OCCURRENCE
$
AGGREGATE
$
DEC RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER(EXECUTNE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
It yes, deeulbe order
DESCRIPTION OF. OPERATIONS below
NIA
WC
027115056 CO
'7/1/2020
-
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, Addltlonal
All worksite employees working for TEAM ELECTRIC, INC., paid under ADP TOTALSOURCE,
under this policy.
Remarks Schedule, may be attached H mor, apsee I, required)
INC.'s payroll, are covered under the above stated policy.. TEAM ELECTRIC, INC. Is an alternate. employer
CERTIFICATE HOLDER I CANCELLATION
CITY OF FORT Caulks
PO BOX 580
-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Fort Collins, CO 80522
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORQED REPRESENTATIVE... ..
ovon
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
' 015821 90005826400 8 02 02 0 0000 0 000
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