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Home My WebLink AboutADP TOTALSOURCE I INC - INSURANCE CERTIFICATE (2)7 M ACCORDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/09/17 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 Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 CONTACT Aon Risk Services, Inc of Florida NAME: PHONE FAX /C Noy 800-522-7514 A/C No Ext : 800-743-8130 A/C, EMAIL ADDRESS: ADP. COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Ins Co 23841 INSURED ADP TotalSource I, Inc. INSURER B : INSURER C : 10200 Sunset Drive Miami, FL 33173 ALTERNATE EMPLOYER INSURER D: INSURER E : National Research Center Inc 2955 Valmont Road, Suite 300 INSURER F : Boulder, CO 80301 C 0VFRAnFS CERTIFICATE NUMBER: 1600663 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 LIMIT S SHOWN ARE AS REQUESTED INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MWDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE R -PR EM SESOEa occurrDence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. POLICY EIPROJECT LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE 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 I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER]MEMBER EXCLUDED? (Mandatory in NH) If yes, describe 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 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. CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE H City Hall West 300 Laporte Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Oqoa OR"A (JetI imi, Qne of cf&, da V ltll t$-ZUI0 AL L)KLI l.uKt UKAI lUn. All rlgnTs reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1111111111111111111111111111111111111111111111111111111111111111111111111111IN •10744797915010'