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`�� CERTIFICATE OF LIABILITY INSURANCE —DATE Y) <br />07 27/13. <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF)IINI%QRMAT ON Oyy Y AND _. FERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT - AFFIRMATIVELY OR tVGATIVE`..Y`AMENC),. EXTEND OR ALTER THE COVERAGE AFFORDED BY THEzPOLICIES <br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A. CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER AND THE CER 'IFICATE HOLDER, <br />IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED; the pplicy(� a) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain lclaslm6y requir9'on'endur ement. A statement on this certificate does not confer rights to <br />pQ <br />the certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />Ace Risk Services. Inset Florida <br />1001 Burkett Bay road, Suite #1100 <br />Miami, FL. 33131 -0937 <br />0/ —Idle <br />CONTACT <br />NAME: Arm Risk SBNIce9, InC 9I Florida <br />PHONE <br />800. 743 -8130 No)! 800- 522 -7514 <br />SExt: <br />M <br />ADP.COLCenler @AOncm� <br />INSURER(S) AFFORDING COVERAGE <br />NAICA <br />AUTHORIZED REPRESENTATIVE <br />INSURERA:No ... I Union Fire las CO of Pittsbury, <br />18445 <br />FORM <br />INSURED _ -- <br />ADP T. aiSource FL XVI, ire, <br />INSURER B: <br />$ <br />INSURER C: <br />S <br />10200 Sunset Ddve <br />Miami, FL 33173 <br />LICIP Pa <br />}Tiih¢1 i%e0ata9 <br />^37108 m iYm fifyi Rd s ... 4 <br />SsROiegc`CA'D213a ­,y <br />INSURER 0, <br />INSURER ET <br />$ <br />....... .. ...... ....m <br />INSURER F: <br />_ <br />COVERAGES CERTIFICATE NUMBER: 546158 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LIMITS. SHOWN. ARE AS REQUESTED. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />INSR <br />WVO <br />POLICY NUMBER <br />POUCYEFF <br />MMIOD/YYYY <br />POLICYEXP <br />MMIDOIYYYY <br />LIMITS <br />GENERAL <br />LIABILITY <br />GCkiMERCIALGENERALLIABILITY <br />CLAIMS -MADE El OCCUR <br />AUTHORIZED REPRESENTATIVE <br />n <br />P OV D AS TO <br />,� q <br />FORM <br />EACH OCCURRENCE <br />$ <br />DAMAPETORENT.- <br />PREMISES Eaoaunance <br />S <br />MED EXP (Anyone 'arson} <br />$ <br />PERSONALk <br />$ <br />GENERAL AGGREGA TE <br />3 <br />GEN'L AGGREGATELIMU APPLIES PER: <br />POLICY PROJECT LOC <br />PRODUCTS. COMPIOP AGO <br />_ <br />S <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />_.. <br />d. -. `a- :;,v <br />Laura "Stitt �hecdy <br />Assistant City AttOr <br />Cy <br />Ep ooddeU $ NGLE LIMIT <br />$ <br />.BODILY INJURY Per poraced <br />It <br />BODILY INJURY Per accim,m <br />$ <br />O ERTY DAMAGE <br />Peraceident)- <br />$ <br />s <br />UMBRELLA LIAR <br />EXCESS LIAR <br />H <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />5 <br />AGGREGATE <br />S <br />ICED I I RETENTION $ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPFIETONPARTNEWEXECUTIVE <br />OFFICEWMEMBER EXCLUDED? <br />(Mandatary in NH) <br />a weer <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WC 038100066 CA <br />01127113 <br />07/07113 <br />X WCSTATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ 2,000,000 <br />EL. DISEASE- EA EMPLOYEEI <br />$ 2,000,000 <br />-EL. DISEASE - PODGY LIMIT <br />S 2,000,009 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ADDED 101, Additional Remarks Schedule, if more space Is required) <br />All wo,kon,..Players wotdng U, the above named clout company, paid antler AAR TOTAL SOURCE, tNC's payroll, ere covered under the obw. slated policy. <br />CERTIFICATE HOLDER CANCELLATION <br />Cilyof Smds Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Public Works Agency <br />THE EXPIRATION DATE THEREOF, NOTICE WILL <br />BE DELIVERED IN <br />W.W Resources Gilson <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />220 S. Daisy Ave, hl 85 <br />Santa Ana, CA 9903 <br />AUTHORIZED REPRESENTATIVE <br />�Eon{j�iakr�'exvieed, 2ixen <br />�f7n�id� <br />© 1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2090/05) The ACORD name and logo are registered marks of ACORD <br />