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j 2 7 E:D ATE (MN1D0lYY) <br />06!16!09 <br />A,CORD CERTIFICATE OF LIABILITY INSURANCE e rtificate( D: 94783 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br />PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />Aon Risk Services, Inc. of FL DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />1001 Bricked Bay Drive, Suite #1100 POLICIES BELOW. NAIL #? <br />Miami, FL 33131-4937 INSURERS AFFORDING COVERAGE <br /> 23841 <br /> INSURER A: New Hampshire Ins Co <br />INSURED <br />ADP TotalSource MI XXX, I- INSURER R <br />10200 Sunset Drive INSURER C: <br />Miami, FL 33173 INSURER D: <br />ALTERNATE EMPLOYER <br />Well Dyne, Inc. INSURER E: <br />7472 S Tuscon Way <br /> MED EXP (Any one perso - <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />? POLICY ? PROJECT ? LOC PRODUCTS - COMPIOP AGG $ <br /> $ <br /> COMBINED SINGLE LIMIT $ <br />AUTOMOBILE LIABILITY (Ea accident) <br />13 ANY AUTO <br />? ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />? SCHEDULED AUTOS (Per person) <br />CI HRED AUTOS BODILY INJURY <br />$ <br />? NON OWNED AUTOS (per accident) <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> AUTO ONLY - EA ACCIDENT $ <br />? GARAGE LIABILITY EA $ <br />? ANY AUTO OTHER THAN ACC <br /> AUTO ONLY: AGG $ <br /> EACH OCCURRENCE $ <br />EXCESS 1 UMBRELLA LIABILITY AGGREGATE $ <br />O OCCUR ? CLAIMS MADE $ <br />?OEDUCTIBLE $ <br /> $ <br />? RETENTION <br />WORKERS' COMPENSATION AND WC 060167003 CO <br />07/01109 07101/10 g WC TORY LIMITS STATu- TS [3 OTHER <br />A <br />EMPLOYERS' LIABILITY Y I N <br />E.L. EACH ACCIDENT <br />$ <br />$2,000,000 <br />ANY PROPRIETOR 1 PARTNER I EXECUTIVE <br />OFFICERJMEMER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />$2,000,000 <br />tMuMatury in NH) E.L. DISEASE - POLICY LIMIT $ $2,000,000 <br />If Yea. dmaibe under <br />SPECIAL PROVISIONS below <br />OTHER <br />En !;wood, CO 80112 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, CERTIFICATE <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUS AN HEREIN IS <br />TO ALL <br />TER CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SOHOW N MAY HAVE BEEN RED CEID BY PAID CLAIMSBJECL1Mi't'S SF OWN ARL^AS RFQUFSj[OFDS AND <br />MAY BE ISSUED OR MAY PERTAIN. THE ISURANCE BY THE POLICIES POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br />INSR AOD'L TYPE OF INSURANCE POLICY NUMBER DATE (MMtOOIYYYY) DATE (MMIDDIYYYY) <br />LTR INSRD EACH OCCURRENCE $ <br />GENERAL LIABILITY <br />DAMAGE TO RENTED $ <br />O COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) - <br />? CLAIMS MADE ? OCCUR -- n) $ ENT DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIOnNdSeA OP DT?TALSOURCEMINC s payroll,Aare cRoveISIOunder the above stated policy. The above <br />All worksite employees working for the above named client company, paid <br />named client is an alternate employer under this policy. <br />GERT{F{CATE',HOLDER CA1+tCELL ATION <br />WELL DYNE, INC. ?Fl QULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br />F p f?ip?aREDF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />7472 S TUSCON WAY NOTICE TO THE <br />7472 S TUSCO CO 60112 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION <br />APPROVED AS TO <br />ENGLEWOOD, OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />of on ovj.§A ifetvic" q". of to <br />,i Laur Stitt Sheedy <br />p1fli3$-2009 ACORU Co kpoRATION,' All rights reserved: <br />ACORD 25 (2009101) ASsistant City AttoTIey <br />The ACORD name and logo are registered marks of ACORD