Laserfiche WebLink
Ae�&& <br />k.1- CERTIFICATE OF LIABILITY INSURANCE <br />IDDIYYYYI <br />F o(8-i 2 Oil 8 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(jes) must have ADDITIONAL INSURED provisions or be <br />endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A <br />statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemont(s). <br />PRODUCER <br />Aon Risk Services, Inc of Flodda <br />1001 l3rickell Bay Drive. Suite 91100 <br />Miami, FL 33i3l-4937 <br />CONTACT <br />NAME: Acm Risk Services, Inc of Florida <br />)-743-8130 ( MC, No): 800-522-7514 <br />EMAIL <br />ADDRESS: ADP.Col.Center@_Aon.com <br />INSURIER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: New Hampshire Ins Co <br />23841 <br />INSURED <br />ADP TotalSourco GO XXII. Inc <br />INSURER B: <br />10200 Sunset Drive <br />INSURERC: <br />Miami, FL 33173 <br />LICIF <br />INSURER D: <br />INSURER E <br />P,L. Custom Body & Equipment Co Inc <br />2201 Atlantic Avenue <br />INSURER F: <br />Manasquan, NJ 08736 <br />COVERAGES CIFIRTIFICATIF NUMBER- 2159363 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE P LiciEs OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLISUBRI <br />INSR <br />WV0 <br />POLICY NUMBER <br />POLICY EFF <br />(MMJDDfYYY-Y) <br />POLICY EXP <br />JMMIDDIYYYY) <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 171 OCCUR <br />EACH OCCURRENCE <br />DAMAGE To R <br />Pit""'. (E. =nce) <br />MED EXP (Any one person) <br />PERSONAL & ADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICYOPROJECT 1:1 LOG <br />OTHER <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COM P/OP AGG <br />S <br />— <br />$ <br />AUTOMOBILE LIA131LITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMBINED SINGLE LIMIT <br />(Fa accident) <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />$ <br />PROPE TY <br />cidefMAGE <br />1per so R <br />$ <br />$ <br />UMI1R11LA IIAII <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEC RETENTION$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANY PROPRIETOWPARTNERJEXECUTIVE <br />OFFICER/MEMEIER EXCLUDE[ <br />(Mandatory in NH) <br />Ifyes,d.­Mnftr <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WC 047023181 NJ <br />07101/18 <br />07101119 <br />X <br />I SPE R, H-: <br />A UIF OETR <br />E.L. EACH ACCIDENT <br />S 2.0K000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 2,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />1 $ 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It more space Is required) <br />All worksita employees working for P.L. CUSTOM BODY & EQUIPMENT CO INC, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. <br />RE: Bid: Spec S — One (1) or More 2018 or Newer Ernergenry Medical Vehicle, <br />------------ <br />CERTIFICATE HOLDER CANCELLATION <br />. . . . . ... . ... . ......... .. ... ...... ...... . ..... <br />City of South Bond <br />Board of Public Works <br />227 West Jefferson St <br />Room 1316 <br />South Bend, IN 46W1 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />12ne- <br />@) 1988-2015 ACC <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />