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HomeMy WebLinkAboutInsurance Certificate: ADP TotalSource I, Inc (2) II'' ACORL?~ CERTIFICATE OF LIABILITY INSURANCE 066105/1/05/1 DATE /YYYY) 8 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 CONTACT Aon Risk Services, Inc of Florida NAME: Aon Risk Services, Inc of Florida 1001 FL all Bay Drive, Suite #1100 aC No, Ext : 800-743-8130 A/C No : 800-522-7514 Miami, , FL 33131-4937 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : New Hampshire Ins Co 23841 INSURED INSURER B : ADP TotalSource I, Inc. 10200 Sunset Drive INSURER C : Miami, FL 33173 ALTERNATE EMPLOYER INSURER D : National Research Center Inc 2955 Valmont Road, Suite 300 INSURER E Boulder, CO 80301 INSURER F : COVERAGES CERTIFICATE NUMBER: 1995654 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 HOVa.; ARE AS RE 01.1ESTF.D INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY MM/DDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ RENTED DAMAGE CLAIMS-MADE F-] OCCUR PREMISES OEa occu ence $ MED EXP An one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG $ OTHER C ED AUTOMOBILE LIABILITY Ea acccid.htSINGLE LIMIT $ 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 OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER A OFFIC ER/MEMBER ANY P ER/MEMBER EXCLUDED? ETOR/PARTNERlEXECUTIVE ❑ NIA WC 047014227 CO 7/1/2018 7/1/2019 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 I 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 Ashland 20 East Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland, OR 97520 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 040,M iph Ina o (flood da ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD .y 1084747