CERTIFICATE OF LIABILITY INSURANCE (953) T2-RV8
DATE(MMIDD/YYYY)
Amo,Ram CERTIFICATE OF LIABILITY INSURANCE
3/19/2019
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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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
NAME:
Commercial Lines PHONE FAX
A/C No Ext: 888-572-2412 AIC No):
USI Insurance Services LLC ADDRESS: certs@trinet.com
2601 South Bayshore Drive,Suite 1600 INSURER(S)AFFORDING COVERAGE NAIC#
Coconut Grove, FL 33133 INSURER A: Indemnity Insurance Company of North America 43575
INSURED
INSURER B
TriNet HR XI, Inc.
INSURERC:
RE: Heath Consultants Incorporated INSURER D:
PO Box 241448 INSURER E:
Charlotte, NC 28224 INSURER F:
COVERAGES CERTIFICATE NUMBER: 14010356 REVISION NUMBER: See below
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
DAMAGE CLAIMS-MADE OCCUR PREM SESOEa o'currDence
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY D PRO-
JECT ❑ LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY VVLRC66051031 3/1/2019 3/1/2020 X STATUTE EORH
2,000,000
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? C N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000
If yes,describe under 2,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Workers'Compensation is limited to worksite employees of Heath Consultants Incorporated through a co-employment contract with TriNet HR XI, Inc.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater Gas System ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
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ACORD 25(2016103)