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HomeMy WebLinkAboutTRINET HR III INC - INSURANCE CERTIFICATE (3)T3-ONE A� ® CERTIFICATE OF LIABILITY INSURANCE °"6�(NI`02 YY"' H 2/2/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INF RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFlRMATNELY OR NEGA IVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NSS NOT CONSTITUTE A CONTRACT BETWEEN THE IUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFI TE HOLDER.. IMPORTANT: If the certificate holder is an ADDITIONA, 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 61der in lieu of such endorsement(s). PRODUCER Commercial Lines - (305) 443-4886 USI Insurance Services LLC 2601 South Bayshore Drive, Suite 1600 Coconut Grove, FL 33133 CONTACT NAME. Risk Management Department PHONE 866 443 8489 FAX ac No 02SOb-889 01 E-MAIL. ADDRESS: work.comp@trinet.com INSURERS AFFORDING COVERAGE NAIC A INSURER A: ACE American. Insurance Company 22667 INSURED TriNet HR 111-A, Inc. L/C/F Masabi LLC 9000 Town Center Parkway Bradenton, FL 34202 INSURER B : INsul¢ERc: INSURER D - INSURER E : INSURER F : r2nvc0er:cl¢ RCOTIRICATC MIINIDkD• 19;n519A9 DClnclnu Put uaDCD. em K-1 ­ 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, mkM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF IN ADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP.. MMID __LIMITS.._. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ TO RENTED CLAIMS -MADE OCCUR PIAMAGE REMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- JECT LOC PRODUCTS - COMP/OP,AGG $ S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $. ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Peraccident - HIRED NON-0WNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LJAS OCCUR EACH OCCURRENCE S AGGREGATE $ E7(CESS IIAB CLAIMS -MADE DED. -RETENTIONS. $ A WORKERS COMPENSATION , AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED4 C (Mandatory in NH) NIA WLR C67662726 O7/O1/2020. 07/01/2021 X .STATUTE ERH E.L. EACH ACCIDENT -- $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 H yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Addit nal Remarks Schedule, may be attached if more space is required) Workers' Cornp'ensation coverage is limited to worksite eniplo ees of Masabi LLC through a co -employment agreement with TriNet HR III -A, Inc. City Of FOR Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N Mason St, PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80524 AUTHORIZED REPRESENTATIVE Mn The ACORD name and logo are rill gistered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016163) 111111111111111111 11111 IIII 111111111111111111111111111111111111111111111111111111111 III IIIIIIIIIIIIIIIIIIIII IIIIIIIII1IIIIIII •CYB01Al2/000661102/02J0010/P