Loading...
HomeMy WebLinkAboutInsurance certificate: ADP TotalSource FL XVIII, Inc. l ® DATE(MMIDD/YYYY) '4 L' CERTIFICATE OF LIABILITY INSURANCE 05/19I2026 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 Ann Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida 701 Brickell Avenue,Suite 3200 PHONE FAX Miami,FL 33131 A/C No,Ext:833-538-2802 A/C No): EMAIL ADDRESS: ADPTS on.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: New Hampshire Ins Cc 23841 INSURED INSURER B: ADP TotalSource FL XVIII,Inc. 5800 Windward Parkway INSURER C: Alpharetta,GA 30005 ALTERNATE EMPLOYER INSURER D: Examinetics Inc INSURER E 10561 Barkley St Ste 400 Overland Park,KS 66212 INSURER F: COVERAGES CERTIFICATE NUMBER: 5149092 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE ❑ OCCUR PREMISES(Ea occu ence) $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 7 PROJECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ COMBINED S ING E LIMIT AUTOMOBILE LIABILITY Ea accident $_ ANY AUTO BODILY INJURY Perperson) $ 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 I I RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY PROPRIETORIPARTNER/EXECUTIVE ❑ WC 051689026 OR 07/01/2026 07/01/2027 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N/A (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 EXAMINETICS INC,paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a 20 East Main THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. a 0 m AUTHORIZED REPRESENTATIVE m m 04on O%sA i6etv[c", 4nc o f6l`7ottda S ©1988-2015 ACORD CORPORATION.All rights reserved. o ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD o 0 0 0