Adashi_Workmans_Comp_-_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 the State of Arizona and Adashi Systems LLC, with the insurance policy covering worksite employees of Adashi Systems LLC paid under ADP TotalSource, Inc.'s payroll. The insurance document is associated with Solicitation Number BPM005086 and is dated for the policy period of 07/01/2023 to 07/01/2024.
The Workers' Compensation insurance policy provides coverage with 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, specifically for jobs performed by Adashi Systems LLC as required by a written contract. The insurance certificate covers all worksite employees of Adashi Systems LLC, with ADP TotalSource, Inc. serving as the alternate employer, and is specifically tied to a state and local contract for services outlined in the solicitation number.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 07/01/2023 07/01/2024 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 034275002 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
07/01/2023 WC 034275002 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 .