HomeMy WebLinkAboutInsurance Certificate: Justworks Employment Group LLC Labor Contractor, for co-employees of: The Freshwater Trust 7TE(MM/DD/YYYY)
A CERTIFICATE OF LIABILITY INSURANCE
/10/2025
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 Justworks Customer Success
NAME:
Doug Jones(Justworks) p/COE
NNo Ext: (888)534-1711 a/c No:
c/o Artex Risk Solutions, Inc. EMAIL
P.O. Box 13838 ADDRESS: support@justworks.com
Scottsdale,AZ 85267 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: American Zurich Insurance Company 40142
INSURED INSURER B:
Justworks Employment Group LLC Labor Contractor,for co-employees of:THE
FRESHWATER TRUST INSURER C:
PO Box 7119 Church Street Station INSURER D:
New York,NY 10008-7119
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:24NY0171238515 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 SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD/YWY MM/DD/YWY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES
Ea occurrrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY ❑ PRO-
❑
JECT LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000
A OFFICER/MEMBER EXCLUDED? ❑ N/A WC 17-93-047-00 01/01/2025 06/01/2025
(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
Location Coverage Period: 01/01/2025 06/01/2025 Client# 169634-OR
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
THE FRESHWATER TRUST
Coverage is provided for 1120 SE Madison Street
only those co-employees
of,but not subcontractors Portland, OR 97214
to:
CERTIFICATE HOLDER CANCELLATION
THE FRESHWATER TRUST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1120 SE Madison Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Portland, OR 97214 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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