2017-074F - Laserfiche WebLink

Home Browse Search

DATE(MM/DD/YYYY) ACORD® CERTIFICATE OF LIABILITY INSURANCE 5/17/2017 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), CONTAPRODUCER SUNZ Insurance Solutions, LLC ID. (Essential) NAME.. - ,Jennifer HaU er C/o Essential HR, Inc. dba First Star HR PHONE 972.404-0295 FAX No: 4455 LBJ Freeway, Suite 1080 E-MAIL �Xt) Dallas, TX 75244 ADDRESSiennifer hauger(a)firststarhr.com INSURERS AFFORDING COVERAGE NAIC If INSURERA SUNZ Insurance Compal 34762 INSURED INSURER B Essential HR Inc _ dba FirstStar HR 4455 LBJ Freeway INSURER D. __ ------ Suite ___Suite 1080 INSURER E. Dallas TX 75244 INSURER F COVERAGES CERTIFICATE NUMBER: 35683740 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, INSR ADDTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LTR MM/DDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE D OCCUR DAMAGES( RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY❑ECT L�LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea""den/ HANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED (Per accident)AUTOS ONLY AUTOS BODILY INJURYP( ) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY {Per accld int) 1 $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION WCPEOODOO184 04 10/1/2016 10/1/2017PER OTH- AND EMPLOYERS'LIABILITY YIN ✓ STATUTE ER ANYPROPR IETOR/PARTN ERIE XEC U TIVEF-1N/A E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1 000 000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 TI I- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of:Timothy Rose Contracting, Inc 1360 SW OLD DIXIE HWY SUITE 106 Effective date: 10/1/2013 Project:North County Sewer&Water CERTIFICATE HOLDER CANCELLATION 62200099 Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1800 27th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Vero Beach FL 32960 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 35683740 1 1 Master Essential HR dba First star HR I Natalie Matthews I S/17/201'/ 7:12 37 AM (CDT) I Page 1 of 1