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HomeMy WebLinkAboutCOI - Choice Employer Solutions, Inc. - Certificate No. 24FL0861141894 | Start Date: 2024-01-19 | End Date: 2025-01-19ACCORD ! CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY) 01 /04/2024 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 INat,IRER(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 1S 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 Andrew Atsaves c/o Artex Risk Solutions, Inc. P.O. Box 13838 Scottsdale, AZ 85267 CONTACT „a NAME; ..�, (480) 951 PHONE FA7(_.._,_..�___ (Aro No. Ext) (4f30� 951 4177 (A/c�No); ^4266� A"MAIL SDL,BSD.Certificates@artoxrisk.00m NAIC # 40142 W_ INSUREIREMErORDIN,C COVERAGE INSURER A: American Zurich insurance t..,erj INSURED Choice Employer Solutions, Inc. dba: Fourth HR Alt. Emp: Securance, LLC dba: Securance Consulting 9007 Brittany Way Tampa, FL 33619 INSURER B INSURER C ; INSURER D ; INSURERS ; INSURER F COVERAGES CERTIFICATE NUMBER: 24FL0861141894 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE'FQR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH !RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB,JECT TO ALL. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OP NSURANCE nt IANSD WVBD POLICY NUMBER . {POLICY M DI D YYYY) (MMI D Y YY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE I [ OCCUR DAICKGfLS Ea rc PRGMISESSEaaccurrence) , $ TM^ $ N' MED EXP (Any one eel ScIl __ PERSONAL & ADV IN.I JRY GEN _ _ L AGOREGIO 1. LIMIT APPLIES PER GENERAL AGGREGATE POLICY I 1 JECTPRO- LOG PRODUCTS - COMP/OPAGG $ OTH R; $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EkeecIdent $ M ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ _ HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE. (Pgr.accident) $ mm $ UMBRELLA EXCESS DED LIAR LIAB 1 RETENTION $ OCCUR CLAIMS.MADE EACIIOCCIIRRENCf AGGREGATE �^$ $ $ WORKERS COMPENSATION AND LIABILITY X PLR SfATUTU "WM f: IA EMPLOYERS ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMaEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N/A X - WC 23^07 669^01 01/19/2024 01/19/2025 ElFACE ACCIDENT r E 'DISSE EA EMPLOYEE L _EA Ed., DISEASE • POLICY LIMIT $ _1 z000,000 $ 1'0001000_ $ 1,000,000 Location Coverage Period: 01/19/2024 01/19/2025 Cliont# 973-FL. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Coverage Is provided for Securance, LLC dba; Securance Consulting Waiver of subrogation Is added to the policy in favor of; Securance LLC 13904 Monroes 9 p 13916 Monroes Business Park Suite 102 Business Park Tampa, FL 33635 Cert Holder: City of Gilroy 7351 Rosanna Street only those co -employees Gilroy, CA 95020 of, but not subcontractors Tampa, FL 33635 to Endorsements; Waiver of Subrogation CERTIFICATE HOLDER City of Gilroy 7351 Rosanna ST Gilroy, CA 95020 CANCELLATION SHOULD ANY OF THE ABOVE DESCRII3ED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2015 ACORD (;ORPORA'F'ION, All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed, 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not enforce our right against the person or organization named in the schedule (This agreement applies only to the extent that you per- form work under a written contract that requires you to obtain this agreement from us,) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be so of the California workers' compensation premium otherwise, due on such remuneration SCHEDULE Person or Organization Job Description IN FAVOR OF: City of Gilroy 7351 Rosanna ST Gilroy, CA 95020 Waiver of subrogation is added to the policy in favor of: Securance LLC 13904 Monroes Business Park Tampa, FL 33635 Cert Holder: City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when thls endorsement is issued subsequent to preparation of the policy,) Endorsement Effective: 01/19/2024 Policy No: WC 23-07-669-01 Endorsement No: Insured: Choice Employer Solutions, Inc. dba: Fourth HR Alt. Emp: Securance, LLC dba: Securance Consulting Insurance Company: American Zurich Insurance Company WC04030.6 Copyright 1983 National Council on Compensation Insurance Countersigned by * 0 S 8 8