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HomeMy WebLinkAboutInsurance Certificate: ADP TotalSource 1 A~ CERTIFICATE OF LIABILITY INSURANCE 06/14/13 snal3 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 endorsements . PRODUCER CONTACT Aon Risk Services, Inc of Flonda NAME: Aon Risk Services, Inc of Florida 1001 Bnckell Bay Onve, Suite »1100 M APHONE I FAX No Ert : 800-743-8130 C No : 800-522-7514 IC MA No, Et): 800-743-8130 A/C . No): 800-522-7514 Miami, FL 331313937 ADDRESS: ADP.COI.Center On.rAm INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: New Hampshire Ins Co 23841 INSURED INSURER B : ADP TotalSource I, Inc. 10200 Sunset Dave 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: 629216 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 ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTR INSR WVD MM/DOrYYYY (MMIDDNYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Eacccunence $ CLAIMS-MADE F-1 OCCUR MED EXP (Anyone person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ COM IN L LIMIT AUTOMOBILE LIABILITY Es aaitlent $ ANY AUTO BODILY INJURY Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILVINJURV Peraccident $ NON OWNED HIRED AUTOS AUTOS Per acdtlent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMBS ER A ANY PROPRIETOR/PARTNERIEXECUTNE ❑ WC 015685231 CO 7/1/2013 7/1/2014 E.L. EACH ACCIDENT $ 2,000.000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE- FA EMPLOYEE $ 2,000,000 If M. deembe under DESCRIPTION OF OPERATIONS below E.L.uISEASE-POLICYLIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) All warksite employees vurking for the above named client company, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above slated 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0401&. 4hkk (Jetriwa, Q/EC of &%eL 6 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD