COI_ADP_Workers_Comp_State_of_AZ.pdf

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

04/27/20

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(ies) 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 rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937

CONTACT

NAME: Aon Risk Services, Inc of Florida

PHONE

(A/C, No, Ext): 800-743-8130

FAX

(A/C, No): 800-522-7514

EMAIL

ADDRESS: ADP.COI.Center@Aon.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : New Hampshire Ins Co 23841

INSURED

ADP TotalSource DE IV, Inc.

10200 Sunset Drive Miami, FL 33173 L/C/F PageUp People Inc.

260 Madison Ave. 8th Floor New York, NY 10016

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: 2756133 REVISION NUMBER:

THIS IS TO CERTIFY 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

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

LIMITS

COMMERCIAL GENERAL LIABILITY

EACH OCCURRENCE $

CLAIMS-MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence) $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $

OTHER $

AUTOMOBILE LIABILITY

COMBINED SINGLE LIMIT

(Ea accident) $

ANY AUTO BODILY INJURY (Per person) $

OWNED

AUTOS ONLY

SCHEDULED

AUTOS BODILY INJURY (Per accident) $

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

PROPERTY DAMAGE

(Per accident) $

UMBRELLA LIAB OCCUR

EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DEC RETENTION $

A

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N

N / A

WC 080385582 NY

07/01/19

07/01/20

X

PER

STATUTE OTH-

ER

E.L. EACH ACCIDENT $ Unlimited

E.L. DISEASE - EA EMPLOYEE $ Unlimited

E.L. DISEASE - POLICY LIMIT $ Unlimited

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for PAGEUP PEOPLE INC., paid under ADP TOTALSOURCE, INC’s payroll, are covered under the above stated policy.

CERTIFICATE HOLDER CANCELLATION

ARIZONA DEPARTMENT OF ADMINISTRATION

STATE PROCUREMENT OFFICE

100 NORTH FIFTEENTH AVENUE, SUITE 402

PHOENIX, AZ 85007

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

© 1988-2015 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

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>> setdistillerparams /HWResolution [2400 2400] /PageSize [612.000 792.000] >> setpagedevice