2022/07/01 ADP TotalSource DE IV, Inc.o.Qo'CERTIFICATE OF LIABILITY INSURANCE DATE (TT/OOffYYY)
06104/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIF'CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTI]ORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lfthe certificate holder is an ADDITIONAL INSUREO, the policy(ies) must have AODITIONAL INSUREO provisions or be endorsed. lI
SUBROGATION lS WAIVED, subject to the terms and conditions ot the policy, certain policies may require an endorsement. A statement on this
certificate does nol confer rights to the certificate holder in lieu of such endorsement(s).
PROOUCER
a drursrd ol Marsh USA lnc.
oa3 Mohes. rA 50306.0686
CONTACi
866.237.4079
AoPTotalSource@,maGh conAOORESS:
INSURER{S) AFFO RDING COVERAGE
INSURER A: AIU hsurance Company 19399
NSURER B
INSURER C
tnsuREo
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5800 Wndrard Parkway
Hrnd6 itard. Ll.m6s & Asso.i.l.s
120 S SIA'I€ COLLEG€ BLVD
sorr.200
Brea, CA 928210000
INSURER D
CERTIFICATE NUMBER:REVISION NUMBER:
INSIJRER E
INSURER F
IHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISIED BELOru HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATEO NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTI]ER DOCUMENT W]TH RESPECT TO V\IiICH THIS
CERTIF1CATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE ATFORO€D AY THE POLICIES DESCRIBED HEREIN IS SU&]ECT TO ALL THE TERMS
EXCLUS]ONS ANO CONDITIONS OF SUCH POLICIES LIM]TS SHO/{N MAY HA!€ BEEN REDUCED BY PAID CLAIMS
TYPEOF INSURANCE ITJSD
POLICYEXP L MITS
COMMERCIALGENERAL LIABILITY
CLAIMS.MADE
GEN L AGGREGATE L MIT APPLIES PER
JECT LOC
OTHER
EACI-] OCCIJRRENCE S
DAMAGE TO RENTEDPREIMISES (Ea o@u.ie.ce)5
[rED EXP (Any one persoi)s
PERSONAL & ADV INJURY 5
GENERAL AGGREGATE 5
PROOUCTS - COMP/OP 466 s
S
COMBINED SINGLE L MIT 5
BOD LY INJURY (Per peen)5
AOO LY NJURY (Per ac. dent)S
S
IJIIIIBRELLA LIAB
EXCESSLIAB
OCCUR
CLAII\46.MADE
EACHOCCURRENCE
AGGREGATE s
DED RETENTION $5
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woil(ERs coittPENsATtoN
ANOEMPLOYERS' LIABILITY
ANYPROPRIETORPARTNEREXECUT VE
OFFICER]UEMBER EXCLUOED'
DESCRTPTIoN oF OPERATIONS bdd
wc 053422880 CA a1ta1Q022 011o112A23
ISIATUTE L ER
E L EACH ACCIDENT $ 2,000 000
EL OiSEASE EA EIVPLOYEE 5 2.000 000
E L OISEASE. POLICY L MlT $ z,ooo,ooo
oEsc RtPtoN oF oPERATTONS ' LOCATTONS / VEHTCLES IACORO 101, Additional Renarks Schedule, may be attach€d rf morc space is rcqurrcd)
Arrworks're emproyees woriing for HINDERLIIER DE LLAMAS & ASSOCIAIES, paid under AOP TOIaLSOURCE, lNC s Paybll, are coveBd undd lhe
AUTO OBILE LIABILITY
oivNEoAUTOS ONLY
HIREDAUTOSONLY
SCHEOULEOAUTOS
NON.OWNED
AUTOSONLY
CERTIFICATE HOLDER CANCELLATION
SHOULO ANY OF THE AEOVE OESCRIBED POUCIES BE CANCELLED SEFORE
THE EXARATION OATE TIIEREOF. NOTICE WLL BE DELIVEREO IN
ACCORDANCE WTTH THE POLICY PROVISIONS,
AUTHORIZ€D REPRESENTAIIVE
(o 1988-2016 ACORD CORP
The ACORD name and logo are registered marks oI ACORD
ACORD 26 (2016/03)lON. All nghts reserveal
COVERAGES
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