The URL can be used to link to this page

COI - ADP TotalSource DE IV, Inc. - Expires 2022-07-01~ -,® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 05/31/2022 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, Inc of Florida NAME: 1001 Brickell Bay Drive, Suite #1100 PHONE I FAX Miami, FL 33131-4937 IA/C, No, Extl: 800-743-8130 iAJC Nol: 800-522-7514 EMAIL ADP.COI.Centerc@Aon.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: AIU Insurance Company 19399 INSURED INSURERS: ADP TotalSource DE IV, Inc. 5800 Windward Parkway INSURERC: Alpharetta, GA 30005 INSURER □: UC/F Hindertiter de Llamas & Associates INSURERE: 120 S State College Blvd Suite 200 Brea, CA 928210000 INSURERF: COVERAGES CERTIFICATE NUMBER: 3896869 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/DDNYYY) (MM/DDNYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -~ CLAIMS-MADE □ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence I $ MED EXP (Anv one cerson) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ~ POLICY □ PROJECT □ LOG PRODUCTS -COMP/OP AGG $ OTHER $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident\ $ - ANY AUTO BODILY INJURY (Per cerson) $ -OWNED -SCHEDULED AUTOS ONLY -AUTOS BODILY INJURY fPer accident) $ -HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ --$ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ --EXCESSLIAB CLAIMS-MADE AGGREGATE $ DEC I I RETENTION $ WORKERS COMPENSATION I PER I I OTH- A AND EMPLOYERS' LIABILITY Y/N we 011092784 CA 03/25/2022 07/01/2022 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE □ OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT $ 2,000,000 (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 2,000,000 !f 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 HINDERLITER DE LLAMAS & ASSOCIATES, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION City of GHroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy,, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE <flon. d{AI< 8e'e.JfUJe!;,, Q11c of cf"lr,,uJa, © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE n -3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 MB 01 000787 97981 H 5 A 1l 11 ll1 111l111 llll 111 l11lll 111 11 1ll1'1l111 11'11'l1 1111 lll1 1111 11 1 THE CITY OF GILROY ITS OFFICERS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY CA 95020-6141 Policy Information: Polley Holder Details precious stone pr Inc Polley Number: Polley Term 76 WEG AL8BM9 05/21/2022 to 05/21/2023 Additional Information: I Policy Type: I Workers' Compensation Dear Valued Customer, Please be aware the above policy has been reinstated effective 06/14/2022. June 3, 2022 D Contact Us Need Help? Start a live chat online or call us at (866) 467-8730. We're here weekdays from 8:00 AM to 8:00 PM ET. Our records indicate that a certificate of Insurance was issued, providing proof of insurance on behalf of the above named insured. This is to inform you that the above policy was cancelled but is now reinstated effective 06/14/2022. All coverage shown on the certificate for this policy is now active. Should you have any questions, please do not hesitate to contact our office. Sincerely, Your Hartford Service Team ReinstCertRC ~ -,.._ l;:- 0 0 0 -== --= --= = --= = ---- tl