07.01.26_COI_WC.pdf
PDF 76 KB Posted
- Attached to
- Master Agreement AZ|CTR073227
- Contract number
- CTR073227
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance issued by Marsh Affinity, a division of Marsh USA LLC, for ADP TotalSource II, Inc., with New Hampshire Insurance Co. as the primary insurer. The certificate covers MBI Acquisition Corp (doing business as MBI Industrial Medicine Inc) and is issued for the State of Arizona, specifically addressed to the State Procurement Office at the Arizona Department of Administration in Phoenix.
The insurance policy provides workers' compensation coverage with policy limits of $2,000,000, effective from 07/01/2025 to 07/01/2026. The policy specifically covers all worksite employees of MBI Acquisition Corp who are paid through ADP TotalSource, Inc.'s payroll. Proprietors, partners, executive officers, and members are included in the coverage, provided they are on the ADP TotalSource payroll or have completed the SEI Participation Addendum. The policy number is WC 063547442 AZ, and it ensures comprehensive coverage for workplace-related incidents and potential liabilities.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_08_Organization_Profile.pdf | ||
| CTR073227_Contract_Amendment__2.pdf | ||
| 11.01.25_COI_PL.pdf | ||
| CTR073227_Contract_Amendment__1.pdf | ||
| CTR073227_MBI_Industrial_Employee_Med_Exam_Svcs.pdf | ||
| Listing_of_all_Service_Locations.xlsx | XLSX spreadsheet | |
| 01.01.26_COI_GL_AL.pdf | ||
| 1-10-25_COI_Cyber.pdf | ||
| 7-1-25_COI_WC.pdf | ||
| AZ_All_Locations_Map.pdf | ||
| Attachment_09.xlsx | XLSX spreadsheet | |
| MBI_Attachment_13_Pricing_Document_rev_8-22-24.xlsx | XLSX spreadsheet | |
| 1-1-25_COI_GL_AL.pdf | ||
| 11-1-24_COI_Med_Liability.pdf |
Show all 14
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Text version
07/11/2025
Marsh Affinity a division of Marsh USA LLC.
PO BOX 14404
Des Moines, IA 50306-9686
Marsh Affinity
800-743-8130
ADPTotalSource@marsh.com
New Hampshire Insurance Co. 23841
A N 07/01/2025 07/01/2026 2,000,000
2,000,000
2,000,000
ADP TotalSource II, Inc.
5800 Windward Parkway Alpharetta, GA 30005 L/C/F:
MBI Acquisition Corp DBA Mbi Industrial Medicine Inc
77 EAST THOMAS ROAD, SUITE 250
Phoenix, AZ 850120000
WC 063547442 AZ
All worksite employees working for MBI Acquisition Corp DBA Mbi Industrial Medicine Inc paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy.
Proprietor/Partner/Executive Officer/Member are not excluded as long as they are in the ADPTS payroll or have completed the SEI Participation Addendum. 5810 Dumfries Drive
State of Arizona c/o: State Procurement Office ATTN: Arizona Department of Administration 1802 W Jackson #100 Phoenix, AZ 85007
X
File details come from the government source that posted it. Updated .