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HomeMy WebLinkAboutCertificate of LiabilityACCMDr CERTIFICATE OF LIABILITY INSURANCE DA TE ) TYPE OF INSURANCE 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(les) 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services, Inc of Florida CONTACT NAME: Aon Risk Services, Inc of Florida PHONE FAX A/C No Ext): 800-743-8130 A/C No): 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 EMAIL ADDRESS: ADP.COLCenter Aon.com ,f°"'° m 1 INSURER(S) AFFORDING COVERAGE NAIC # 4 e '.�,N INSURER A : AIU Insurance Company 19399 PERSONAL &ADV INJURY $ INSURED JUN 14 ZOZZ ADP TotalSource DE IV, Inc. INSURERS INSURER : 5800Windward Parkway Alpharetta.O005 OF LOS ALMS HILL1 INSURER D: Hnderlitede Llamas &Associates 600 INSURER E: 120 S State College Blvd Suite 200 INSURER F : Sr.., CA 928210000 COVERAGES CERTIFICATE NUMBER: 3897235 REVISION NUMBF_R- THIS IS TOCERTIFY 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY POLICY EXP MM/DDIY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any one erson $ PERSONAL &ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ PROJECT El LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ FDEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC 011092784 CA 03/25/2022 07/01/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Los Altos Hills, Its elective and appointed officers, employees and volunteers 26379 Fremont Blvd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Los Altos Hills, CA 94022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE pp 0#00 L6k r�C'9:VL `final, Qaa Q t$wda ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD