Adashi_Workmans_Comp_2_-_2024.pdf
PDF 130 KB Posted
- Attached to
- Master Agreement AZ|CTR075960
- Contract number
- CTR075960
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance and Waiver of Subrogation Endorsement issued by Marsh Affinity, a division of Marsh USA LLC, for ADP TotalSource MI VI, LLC, with New Hampshire Insurance Co. as the insurer. The certificate involves Adashi Systems LLC as an alternate employer and is specifically related to a contract with the State of Arizona, with the solicitation number BPM005086. The insurance policy covers worksite employees of Adashi Systems LLC who are paid under ADP TotalSource, Inc.'s payroll.
The Workers' Compensation insurance policy is valid from 07/01/2022 to 07/01/2023, with coverage limits of $2,000,000 for each accident, disease-each employee, and disease-policy limit. The document includes a Waiver of Subrogation in favor of the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, specific to jobs performed by Adashi Systems LLC as required by written contract. The policy is issued with the policy number WC 053414676 MD and applies to work performed under the specified solicitation, though it notes non-applicability in certain states including California, Kentucky, and New Jersey.
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Text version
05/31/2023
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 07/01/2022 07/01/2023 2,000,000
2,000,000
2,000,000
ADP TotalSource MI VI, LLC 5800 Windward Parkway Alpharetta, GA 30005 Alternate Employer:
Adashi Systems LLC
101 N. HAVEN STREET SUITE 301
Baltimore, MD 212240000
WC 053414676 MDX
All worksite employees working for Adashi Systems LLC paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. Adashi Systems LLC is an alternate employer under this policy. WAIVER OF SUBROGATION IN FAVOR OF the State of Arizona and its departments, agencies,boards, commissions, universities, officers, officials, agents, and employees AS RESPECTS OF JOB PERFORMED BY Adashi Systems LLC AS REQUIRED BY WRITTEN CONTRACT. Solicitation Number
BPM005086
State of Arizona 100 N 15th Avenue Phoenix, AZ 85007
X
07/01/2022 WC 053414676 MD
ADP TotalSource MI VI, LLC 5800 Windward Parkway Alpharetta, GA 30005 Alternate Employer:
Adashi Systems LLC
101 N. HAVEN STREET SUITE 301
Baltimore, MD 212240000
New Hampshire Insurance Co.
WAIVER OF SUBROGATION IN FAVOR OF the State of Arizona and its departments, agencies,boards, commissions, universities, officers, officials, agents, and employees AS RESPECTS OF JOB PERFORMED BY Adashi Systems LLC AS REQUIRED BY WRITTEN CONTRACT.
Solicitation Number BPM005086
File details come from the government source that posted it. Updated .