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HomeMy WebLinkAboutInsurance Certificate: ADP TotalSource 1 Inc '`� CERTIFICATE OF LIABILITY INSURANCE DAT06/141DIVYYY) 06/14/12 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 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 ADD Risk Services,Inc O(Florida Ann Risk Services,Inc of Florida NAME: 1001 Bnckell Bay Drive,Suite#1100 AIC,No,EXt:8O0-743-8130 AIC,No):800-522-7514 Miami,FL 33131-493] EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S)AFFORDING COVERAGE NAICN INSURER A; New Hampshire Ins Co 23041 INSURED INSURER B: ADP TotalSource 1,Inc. 10200 Sunset Drive INSURER C Miami,FL 33173 ALTERNATE EMPLOYER INSURER D National Research Center Inc INSURER E 2955 Valmont Road,Suite 300 Boulder,CO 80301 INSURER F COVERAGES CERTIFICATE NUMBER: 472819 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR MD MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 71 OCCUR MED E%P(Any one emon $ PERSONAL 8 ACV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ CM AUTOMOBILE LIABILITY Ea =S INGLE LIMIT $ ANY AUTO BODILY INJURY Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peraccident $ NON-OWNED PROPERTY UAMAU E J —HIREDAUTOS AUTOS Per aced nt $ 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEC I I RETENTION$ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 2,000,000 OFFICERIMEMBER EXCLUDED? NIA WC 038087762 CO 711/2012 7/1/2013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2.000,000 If ye,de=p� ume, DESCRIPTION OF OPERATIONS below -- E.L DISEASE-POLICY LIMIT $ 2.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks schedule,IT more space Is required) All v rksde employees working for the above named client company,paid under ADP TOTALSOURCE,INC's payroll,are mvered under the above stated policy. The above named client is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 JUN 2 1 2012 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE agon p�L&k 8exvicee, Qnc of(flotida ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD