HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (29)'T 0
ACCORD CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
06/05(18
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 endorsements .
PRODUCER
CONTACT Aon Risk Services, Inc of Florida
NAME:
Aon Risk Services, Inc of Florida
PHONE FAX
1001 Brickell Bay Drive, Suite #1100
Ext : 800-743-8130 A/C, No): 800-522-7514
Miami, FL 33131.4937
EMAIL
ADDRESS: ADP.COI.Center@Aon.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: New Hampshire Ins Cc
23841
INSURED
INSURER B :
ADP TotalSource 1, Inc.
10200 Sunset Drive
INSURER C :
INSURER D :
Miami, FL 33173
ALTERNATE EMPLOYER
INSURER E :
National Research Center Inc
2955 Valmont Road, Suite 300
Boulder, CO 80301
INSURER F
COVERAGES CERTIFICATE NUMBER: 1920376 REVISION NUMBER:
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. OMITS S.HO,NN ARF. AS REQUESTED
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE _
$
CLAIMS -MADE ❑ OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MED EXP (Any oneperson)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
POLICY 7 PROJECT ❑ LOC
OTHER
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY Per person)
$
ANY AUTO
BODILY INJURY Per accident
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
PROPERTY DAMAGE
Per accident)$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DEC I I RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNERIEXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N / A
WC 047014227 CO
7/1/2018
7/1/2019
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
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
All worksite employees working for NATIONAL RESEARCH CENTER INC, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. NATIONAL RESEARCH CENTER INC
is an alternate employer under this policy.
rr_orrrlreTG uni nGR CANCELLATION
CITY OF FORT COLLINS
City Hall West
300 Laporte Avenue
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
on gA 8gttvcoe.r, litre of gRotida
Oc 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
n.
+mot. 1084762