HomeMy WebLinkAboutADP TOTALSOURCE CO XXI INC - INSURANCE CERTIFICATE (11)ACORL� CERTIFICATE OF LIABILITY O BILITY INSURANCE DAT5/15/D/YYYY)
S/15/20
THIS CERTIFICATEIS 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 cermicate.does not confer rights to tAe certificate holder in.11eu of such endorsemen s .
PRODUCER CONTACT
Aon Risk Services, Inc of Florida NAME: AOn Risk SOfVICeS, Inc Of Florida
Bell Bay Drive, Suile #1100 No . (FAX.
Miami, FIL 331314937 NC NExt 800-743-8130No 800-522-7514
,
_ INSURER(S)AFFORDING COVERAGE_
NAIC II
INSURER A: New Hampshire Ins Co
23801
INSURED
ADP TotalSource MI XXX, Inc.
10200 Sunset DrIw
Miami, FL 33173
ALTERNATE EMPLOYER
Blsho -Br p Ogden Associates, Inc. D8A BRA Water Consultants, Inc
333 W. Hamptlen Ave., Suite 1056
Englewood, CO 80110
INSURER B :
INSURER C :
- - -
INSURER D :
- -- -
INSURER E:
INSURER F :
COVERAGES CFRTIFICATFI
NUMRFR- 7777RSR RFVISION NIIMRFR.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERMIOR
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
BELOW HAVE BEEN 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 SHOWN ARE AS REQUESTED
INSR
LTR
TYPE OF INSURANCE
ADOL
INSR
SUBR
WVID
POLICY NUMBER
POLICY EFF
MMID
POLICY EXP
MWDD
LIMBS -
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MEO EXP An .one rson _ .
$
PERSONAL 8 ADV INJURY
$
GENL AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT ❑ LOC
OTHER
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGO
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED - SCHEDULED
AUTOS ONLY AUTOS
HIRED ,. NON -OWNED
AUTOS ONLY AUTOS ONLY
CO MBI E SIN LE IM LI
Ea accident
$
BODILY-IWURY. Per person).
$
BODILY INJURY Per accident
$
PROPERTY DAMAGE
Per edddent
$
$
UMBRELLA LUI8
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH. OCCURRENCE
$
AGGREGATE
$
DEC RETENTION $
A
WORItER$COMPENSATION
AND EMPLOYERS' LIABRJTY YIN
ANY PROPRIETORIPARTNERJEXECUTNE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
dyes deealbeunder
.DESCRIPTION OF OPERATIONS below
N I A
WC 027115056 CO
7/112020
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 / LOCATIONS / VEHICLES (ACORD 101, AddlBonal
All worksite employees working for BISHOP-BROGDEN ASSOCIATES, INC. DBA
policy. BISHOP-BROGDEN ASSOCIATES, INC. DRA BSA WATER CONSULTANTS,
Remarks Schedule, may be attached if more space Is requlred)
BSA WATER CONSULTANTS, INC, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated
INC is an alternate employer under this policy.
Ill =I:i91;1WAI=11:Will a]=1: ILa3=111111 "- iral:
City of Fort Collins - Purchasing
P.O. BOX 580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Fort Collins, CO80522
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�!
Own atne"
U 1888-20115 ACORO CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
W'•a 000350 90005825900 8 02 02 0 0000 0 000
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