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HomeMy WebLinkAboutTRINET HR III INC / PROPERTYROOM.COM INC - INSURANCE CERTIFICATE (2)AI G-J I-5 AC"R"® CERTIFICATE OF LIABILITY INSURANCE D ATE DlYYYY) 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 NAME:-- Risk Management Department _ Commercial Lines - (305) 443-4886 PHONE 8664438489 FAx 8008890021 Wells Fargo Insurance Services USA, Inc. �Lo Ex (AlC, No): ADDRESS: Work.Comp@Trinet.com 2601 South Bayshore Drive, Suite 1600 INSURER(S) AFFORDING COVERAGE NAIC# Coconut Grove, FL 33133 INSURER A: Indemnity Insurance Company of North America 43575 INSURED INSURER B : _ TriNet HR III, Inc. INSURERC: RE: PropertyRoom.com, Inc. INSURERD: 9000 Town Center Parkway INSURER E. Bradenton, FL 34202 INSURER F : COVFRAQFR rFRTIFIRATF IUI IIMARFR• 12000745 CC\/ICIrIW su uaoCo. coo ti-l—, 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. INSR LTR TYPE OF INSURANCE DL U R POLICY NUMBER POLICY EFF MMIDDlYYYY POLICY EXP MMIDDIYYYY --- LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S AMAGE7"SNTE0_ _ CLAIMS -MADE D OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY S GEN'L ___ AGGREGATE LIMIT APPLIES PER PRO - POLICY JECT LOC GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a ccident $ _ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( 1 S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE i $ EXCESS LIAB CLAIMS -MADE DIED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANYPROPRIETOR/PARTNER/EXECUTIVE YIN REXCLUDED? N OFFICE(Mandatory N J A WLRC64417812 7/1 /2017 7/1 /2018 X STATUTE EO RH- E.L. EACH ACCIDENT 2,00 ,000 $ E.L. DISEASE - EA EMPLOYEE $ 2,000,000 in N (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT S 2,000,000 DESCRIPTION OF OPERATIONS below 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 PropertyRoom.com, Inc. through a co -employment contract with TriNet HR III, Inc. I c nvwcrc City of Fort Collins 215 North Mason St Fort Collins CO 80522 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 At s ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. 1 III III III 1111111111111111111111111111111111111111111111 ����� 11111111111111111111 III 1111 .""05A27/003133/02/02/0/0,0/0•