HomeMy WebLinkAboutTRINET HR III INC/ HUMPHRIES POLI ARCHITECTS P C - INSURANCE CERTIFICATEAIG-LEC
,aco CERTIFICATE OF LIABILITY INSURANCE 76E
/2 /201 YVY)
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).
PRODUCER CONTACT
Commercial Lines - (305) 443-4886 PHONE Risk Management Department - FAX
o Ext : (866}443-8489 tq� No) (800)889-0021
Wells Fargo Insurance Services USA, Inc. E-MAIL
Work.Comp@Trinet.com
2601 South Bayshore Drive, Suite 1600 INSURER(S)AFFORDING COVERAGE NAICit
Coconut Grove, FL 33133 INSURERA: Indemnity Insurance Company of North America 43575
INSURED INSURER B ;
TriNet HR III, Inc. — —
_
RE: Humphries Poli Architects, P.C. INSURER C :INSURERD:
9000 Town Center Parkway INSURER E :
Bradenton, FL 34202 INSURER F :
rOVFRAr.FS r 1=PTIFICATI= KI]IWIRCD. 1755.ri79
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.
ILT R
LTR
OF INSURANCE
ADD —TYPE
INSO
UBR
POLICY NUMBER
MMI —POLDIYYYY
MM/DDIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE C—J OCCUR
EACH OCCURRENCE
$
AMAGETCM
PREMISES (Ea occurrence)$
MED EXP (Any one person)
_
$
_
PERSONAL & ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO- ❑
JECT LOC
GENERAL AGGREGATE
$
PRODUCTS • COMP/OP AGG
-
$
$
OTHER:
AUTOMOBILE
_
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
S
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident)
$
$
W
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$
DED I RETENTION $
I
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICERJMEMBER EXCLUDED? N.
N r A
WLRC64417691
7/1/2017
7/1/2018
PER OTH-
X STATyTE ER
E.L. EACH ACCIDENT
_
2,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
(Mandatory in NH)
If yes. describe under
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
DESCRIPTION OF OPERATIONS below I
I
I
i
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
Workers Compensation is limited to worksite employees of Humphries Poll Architects, P.C. through a co -employment contract with TriNet HR III, Inc.
City of Fort Collins
PO Box 580
Fort Collins CO 80522
r lrMr4%rGLL1A I IVN
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
9(-V'4.'1'
ACORD 25 (2016/03)
I ne ALUKU name and logo are registered marks of ACORD OO 1988-2015 ACORD CORPORATION. All rights reserved.
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