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HomeMy WebLinkAboutInsurance Certificate: TriNet Group Inc L/C/F Policy Confluence DBA POLCO uvu l [)AT (MMIDD/YYYY)� '`� D® CERTIFICATE OF LIABILITY INSURANCE 06/05/2022 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 SOUTH INC NAME: , • 3550 LENOX ROAD NORTHEAST PHONE FAX SUITE 1700 A/C No,Ext):833-506-1544 , (A/C,No): ATLANTA GA 30326EMAIL ' ADDRESS: work.comp@trinet.com . INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ACE Fire Underwriters 20702 INSURED INSURER B: TriNet Group,Inc.L/C/F Policy Confluence,Inc.DBA POLCO 1 Park Place,Suite 600 INSURER C: Dublin,CA 94568-7983 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15543659 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. INSR' TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR DAMAGE TO RENTED PREMI$E8(Eaoccurn:nce) $ _, MED EXP(Any one person) $ — PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ — POLICY ri PROJECT n LOC PRODUCTS-COMP/OP AGG $ — OTHER $ LIABILITY COMBINED SINGLE LIMIT AUTOMOBILE (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 V EACH OCCURRENCE _ $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION$ WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS'LIABILITY Y/N , ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBEREXCLUDED? n N/A SCF_C71283963 07/01/2022 07/01/2023 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) Workers Compensation coverage is limited to worksite employees of Policy Confluence,Inc.DBA POLCO through a co-employment agreement with TriNet HR III,Inc.. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND OREGON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AND ITS ELECTED OFFICIALS,OFFICERS&EMPLOYEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND,OR 97520-1850 AUTHORIZED REPRESENTATIVE dfon di. 6etvlces 6outlt (Inc ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r ` '+,+.i 019559 90020850900 6 02 02 0 0000 0 000 Aon Risk Services,Inc. of Florida C/O Venture Solutions-TriNet 1170 Grey Fox Road Arden Hills,MN 55112 CITY OF ASHLAND OREGON N AND ITS ELECTED OFFICIALS.OFFICERS &EMPLOYEES 20 E MAIN ST i ASHLAND OR 97520-1814 1111111111111111 11111111111111111IIiIII1111.11111 hiiiIIiil • rase019559 90020850900 6 02 01 1 0000 0 000 1023059