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HomeMy WebLinkAboutInsurance Certificate: ADP Total Source II, Inc F DATE (MMiDD[YYYY) 06/05/18 '`~~QRn CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT Aon Risk Services, Inc of Florida Aon Risk Services, Inc of Florida NAME: 1001 Brickell Bay Drive, Suite u1100 PHONE FAX Miami, FL 33131-4937 A/C, No, Ext : 800-743-8130 A/C, No : 800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : New Hampshire Ins Co 23841 INSURED INSURER B : ADP TotalSource II, Inc. 10200 Sunset Drive INSURER C : Miami, FL 33173 ALTERNATE EMPLOYER INSURER D : Century West Engineering Corporation INSURER E 5331 Sw Macadam Ave, Portland, OR 97239 INSURER F : COVERAGES CERTIFICATE NUMBER: 2063508 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. Ur 'c: f ,NN AR4 REf.AUESTLD INSR 1 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR _ INSR WVD MM/DD/YYYY MMIDD/YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ OCCUR PRE. SES Ea oxurr $ MED EXP An one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG $ OTHER CON16iNED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED - - AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION $ WORKERS COMPENSATION X PER I OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? N / A WC 047031778 OR 7/1/2018 7/112019 E.L. EACH ACCIDENT $ 2,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 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 CENTURY WEST ENGINEERING CORPORATION, paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. CENTURY WEST ENGINEERING CORPORATION is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION City of Ashland Public Works 20 East Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashlana, OR 97520 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f f 04on 1L6A L" YL+CL3, Sort o < f jjo j da ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD yL~,::. 101.7347