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HomeMy WebLinkAboutTRINET HR III INC / PROPERTYROOM.COM INC - INSURANCE CERTIFICATET3-JL5 A/ ® DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/25/2018 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 CONTANAME: CT Risk Management Department Commercial Lines - (305) 443-4886 PHONE g664438489 FAX 8008890021 C No E t : AIC No): USI Insurance Services National, Inc. E-MAIL ADDRESS: Work.Comp@Trinet.com 2601 South Bayshore Drive, Suite 1600 INSURER(S) AFFORDING COVERAGE NAIC u Coconut Grove, FL 33133 INSURERA: Indemnity Insurance Company of North America 43575 INSURED INSURER B TriNet HR III, Inc. INSURER C RE: PropertyRoom.com, Inc. INSURERD: _ 9000 Town Center Parkway INSURERE: Bradenton, FL 34202 INSURERF: rOVFRAGIPS C:FRTIFIrATF NI IMRFR• 13211440 RFVIRInfJ NI IMRFR• Spp hpinw 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. INS LTR TYPE OF INSURANCE ADDL INSD SUER WVQ POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGEPREMISES S ( ERENaoccTED urrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMPIOP 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) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ Is UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB 17 CLAIMS -MADE DED I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? C (Mandatory in NH) NIA WLR C65440817 — 7/1/2018 7/1/2019 X SEATUTE EORH E.L. EACH ACCIDENT $ 2.000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 2,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if 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. 1�11;�11�L�L•II�i1�1�93: �It1PL�JaAAG\Ill►` City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 North Mason St ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1111111111111111111111111111111111111111 IN 11111111111111111111111111111111111111111111111111111 'CY801 A25/001546/02J02/D/0lO/0'