CERTIFICATE OF LIABILITY INSURANCE (681)CERTIFICATE OF LIABILITY INSURANCE I DA03/31/2015 Y'
THIS CERTIFICATE IS ISSUED AS A MA7TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE 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 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).
PRODUCER CONTACT
Stonehenge Insurance Solutions, Inc. PHONE FAx
300 Avenue of the Champions ,4/c No ext : 561-746-5027 A/C No :
Ste. 222 E-MAIL
Palm Beach Gardens, FL 33418 ADDRESS:
INSURERISI AFFORDING COVERAGE NAIC #
INSURED
Einstein HR Inc.
3805 Crestwood Pkwy., Suite 100
Duluth, GA 30096
COVERAGES
CERTIFICATE NUMBER:BZ5gc13EF
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
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 RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE 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 TypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE RENTED
PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG �$
POLICY PR� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERN DAMAGE
HIRED AUTOS AUTOS Per accident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
OED RETENTION $ $
A WORKERS COMPENSATION TWC3473474 04/01/2015 04/01/2016 X ORY L M TS �ER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N 1,000,000
OFFICER/MEMBER EXCLUDED? � N� A E.L. EACH ACCIDENT $
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS be�ow E.L. DISEASE - POLICY LIMIT $
$
$
$
$
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Coverage is extended to Co-employees as assigned and approved by Einstein HR, but not subcontractors of Quorum Services, LLC, QPPS, Inc. effective 1/26/15.
City of Clearwater
Attn: Development Services Director
100 S. Myrtle Ave.
Clearwater, FL 33756
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SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE 8 ��:�. ,�::-:1�
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Page 1 of 1 O 1988-2010 ACORD CORPORATION. All rights reserved.
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