7-1-25_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. The certificate involves New Hampshire Insurance Co. and covers worksite employees of MBI Acquisition Corp (doing business as MBI Industrial Medicine Inc) who are paid through ADP TotalSource's payroll. The certificate holder is the State of Arizona, specifically the State Procurement Office and Arizona Department of Administration located in Phoenix.
The insurance policy provides Workers' Compensation coverage with policy limits of $2,000,000 for each accident, each employee's disease, and the overall policy limit. The policy is effective from 07/01/2024 to 07/01/2025, with the specific policy number WC 088408481 AZ. The certificate indicates that all worksite employees of MBI Acquisition Corp working under ADP TotalSource's payroll are covered under this insurance policy, serving as a comprehensive liability protection mechanism for the employees and associated entities.
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Other files
| File | Type | Posted |
|---|---|---|
| 01.01.26_COI_GL_AL.pdf | ||
| 1-10-25_COI_Cyber.pdf | ||
| AZ_All_Locations_Map.pdf | ||
| Attachment_09.xlsx | XLSX spreadsheet | |
| MBI_Attachment_13_Pricing_Document_rev_8-22-24.xlsx | XLSX spreadsheet | |
| Attachment_08_Organization_Profile.pdf | ||
| CTR073227_Contract_Amendment__2.pdf | ||
| 07.01.26_COI_WC.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 | |
| 1-1-25_COI_GL_AL.pdf | ||
| 11-1-24_COI_Med_Liability.pdf |
Show all 14
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Text version
09/04/2024
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 07/01/2024 07/01/2025 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 100 Phoenix, AZ 85012
WC 088408481 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.
State of Arizona c/o: State Procurement Office ATTN: Arizona Department of Administration 1802 W Jackson #100 Phoenix, AZ 85007
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File details come from the government source that posted it. Updated .