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HomeMy WebLinkAboutADP TOTALSOURCE CO XXI INC - INSURANCE CERTIFICATE (12)ACOROr CERTIFICATE OF LIABILITY INSURANCE DATEos/os/n(09/1YYYV) 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 Aon Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX A/C No Ext : 800-743-8130 A/C. No): 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131 A937 MAIL ADDRESS: ADP.COI Center on.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSource CO XXI, Inc. INSURER B : INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D : ALTERNATE EMPLOYER GDL INDUSTRIES INC DBA Mr Rooter Plumbing 3801 GODDING HOLLOW PKWY, INSURER E : INSURER F : Frederick, CO 80516 COVERAGES CERTIFICATE NUMBER: 1681257 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. LIMITS SHOWN ARE 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 CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO R PREM SES (E. occu ence)$ MED EXP (Any oneperson) $ PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER. POLICY PROJECT ❑ LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY M IN I L LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, de —be under DESCRIPTION OF OPERATIONS below N / A WC 026160309 CO 7/1/2017 7/1/2018 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for GDL INDUSTRIES INC DBA MR ROOTER PLUMBING, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. GDL INDUSTRIES INC DBA MR ROOTER PLUMBING is an alternate employer under this policy CERTIFICATE HOLDER CANCELLATION City of Fort Collins 300 Laporte Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fort Collins, CO 80521 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE oqan C1sk 8e tiv&e.6, 9.ni,c a (f&,t!da ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 11111111111111111111111111111111111111111111111111111111111111111111111111111111 •10472378947010'