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HomeMy WebLinkAboutPW13-226 - Insurance Certificate - Zayo Group, LLC - Liability Coverage - 07/01/2015 CERTIFICATE OF LIABILITY` INSURANCE DAT 01/2 I7i7dYYYYI 01 l2811 G 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 INSURERS), AUTHORIZED' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT;If the certificate holder is an ADDITIONAL INSURED,the policy(Iesj must 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 endorsements . PRODUCER CONTACT Aan Rusk Services,Incof Florida NAME: Ann Risk Services,Inc of Florida 1001 Brickell Bay Drive.Suite#1100 PHONE FAX Nox :800-743-810 -5 22-7514Miami,FL 33131-4937 CIL NQL M ADDRESS: ADP.COI.Centerr(JAon.com INSURERISI AFFORDING COVERAGE NAIL CC INSURER A: New Hampshire Ins Co 13841 INSURED INSURER B: ADP TotalSourceMll V0,'LLC 10200 Sunset Drive INSURER C Miami,FL 33173 ALTERNATE EMPLOYER. INSURER D r Zayo Group LLC Di Zayo Group LI-C INSURER E: 4772 Walnut SL Suite 1..00 Suite 100.CO 803010000 INSURER F: COVERAGES CERTIFICATE NUMBER: lo555os 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 TYPE OF INSURANCE AODL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVO MM1DUlYYYY MMID..DIYYYY. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE T©RENTED CLAIMS-MADE OCCUR PREMFISESIEamcunence) S MEDEXP(Any oneperson) S PERSONAL&.ADV INJURY S GENT.AGGREGATE LIMIT APPLIES PER: GENERAL,AGGREGATE S POLICY ❑PROJECT❑LOC PRODUCTS-CCMdP/OP AGG 5 OTHER S COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accldant S ANY AUTO EODILYIINJ'URY iPer ersori'h S ALL GMdNIED SCHEDULED AUTOS AUTOS EOOILY INJURY fFeraccident) S NON-OvVN'EL7 Yr'R(.1PEtI DAMAGE HIREDAUTOS AUTOS Peraccidenl S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EIEXCESS LAB CLAIMS-MADE AGGREGATE S DEC I I RETENTIONS WORKERS COMPENSATION X PER. OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE: ER ANY PROPRVETORPPARTNs2PYEXF:Cr1TVVP' ^a u/1/201G 1=l FA+rw.t-iA..i..r._N A F NC 034123�E8 CO 7/112015 5 2,00D,0flD iirro�,�.r�t�rvtiEPvYaEriE:,r.,LuT%rD�. �.t;lfi —.. (Mandatory In.NH) EL]l,EASE-EA EMPLOYEE' $ 2,000,000 It" descx N,-do DESCRIPTION OP OPERATIONS below ",ASE-POLICY LIMIT S 2,000,000 VW'ORKERS' COMPENSATION & EMPLOYERS' LIABILITY COVERAGE FOR Zayo Group LLC DRA Zayo Group LLC TERMINATED EFFECTIVE 1d1/2415 DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES IACORD 101,Additional Remar'ks..Scftedtlle,may be attached if more space is required) AI worksite employees working for ZAYO GROUP LLC DEA ZAYO GROUP LLC,paid under ADP TOTAL5OURCE„INC."s payroll,are covered under the above stated policy. ZAYO GROUP LLC OBA ZAYO GROUP Li is an alternate employer under this polVcy. COVERAGE INCLUDES ALL STATES EXCEPT THOSE THAT Al MONOPOLISTIC(OH,ND,V Y and.WA). CERTIFICATE HOLDER CANCELLATION City of Kent SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 220 Fourth Avenue South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98403 AUTHORIZED REPRESENTATIVE 1988-2014 ACORD CORPORATION.AII rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD m