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2015-363-E HR - Flores & Associates, LLC - Medical Reimbursement and Dependent Care Assistance Claim Administration Agreement
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2015-363-E HR - Flores & Associates, LLC - Medical Reimbursement and Dependent Care Assistance Claim Administration Agreement
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6/2/2016 11:42:31 AM
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7/29/2015 9:59:39 AM
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BOCC
Date
7/28/2015
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Work Session
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Agreement
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R 2015-363-E HR - Flores & Associates, LLC - Medical Reimbursement and Dependent Care Asst. Claim Admin. Agreement
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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 <br /> � �)CERTIFICATE F LIABILITY INSURANCE <br /> �2l��io� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Cindy Sherrill CBIA CISR <br /> NAM.-: <br /> First Citizens Insurance Services PHaNE ;. (704)338-3837 1 FAC N.. (366)578-4503 <br /> P O Box 29611 E-MAIL <br /> AODRESS:rind y.sherrill @fisstcitizens-coaaL <br /> INSURER(S)AFFORDING COVERAGE NAIL# <br /> Raleigh NC 27626-0611 INSURERA:Sentinel Ins Co, LTD 11000 <br /> INSURED INSURER B:Ha.rtford Ins Co of Midwest 37478 <br /> Flores & Associates LLC INSURER c:Federal. Insurance CqTpany 20281 <br /> PO Baas 31397 INSURER D: <br /> INSURER E <br /> Charlotte NC; 28231 INSURER r <br /> COVERAGES CERTIFICATE NUMBER:14-15 Master COI 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 ANE CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ENSR I TYPE OF INSURANCE INSR 5U POLICY <br /> LTR D POLICY NUMBER MMIGD?YYYY MMDDIYYYY LIMITS <br /> GENERAL LIABILITY FACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIAB'�LIlY $ <br /> DAMAGE TO RENTED 1,000,000 <br /> PREMISES Eacccunence <br /> A C[AIMS-MA.DF 7X OCCUR X 228BAZG3564 661/2014 6/1,12015 NiFDFXP(Any ore F:erscm) $ 10,000 <br /> PERSONAL&r1DVINJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIV T APPLES PER. PRODUCTS-COMP OP AGG $ 2,000,000 <br /> ----- ------ ----- ------------------------------------------------------------------------ <br /> X POLICY F•R.t I_C1C $ <br /> AUTOMOBILE LIABILITY COIL NED SINGL.E LIVIT <br /> ANY AUTO BODILY'INJURY(Per person) $ <br /> All_OLtiNED SCHEDULED BODILY INJURY(Pcr accident) $ <br /> AUTOS AUTOS <br /> NCJN-DVVKrD PROPERZDAMAGE $ <br /> H IRFCI AUTOS AUTOS FP.r acrid©nt <br /> X UMBRELLA LIAB OCCUR 28BAZG3564 8/1/2014 8/112015 EACH OCCURRFNCF $ 1,000r Q00 <br /> A EXCESSLIAB GLAIMS-MADE AGGREGATE $ 1,000,000 <br /> DFD I I RFTFNTON 10,03 $ <br /> B WORKERS COMPENSATION X AIC STATU- UTH- <br /> AND EMPLOYERS'LIABILITY Y f N <br /> ANY PRCPRFTCRlPARFNFWEXFCUT IVF F7N NIA <br /> E.L.EACH ACCIDENT $ 500 000 <br /> OFI=l CFF2JMEh1ELR EXCLUL`I=6? tY° B�r,g76S6 8j1/2014 8f112015 <br /> (Mandarcry in NH) EL FT,,FAaF-FA EPAPLOYE $ .100 000 <br /> If yes.describe wider <br /> DESCRIPTION OF OPERATIONS 6dow E.L.DISEASE-P'0L LIMIT $ 500 000 <br /> lird Party Crime 2 TP 0267837 15 01/01/2015 01/01/2016 $1,000,000 Limit $25,000 De <br /> emises Greenville, Sr <br /> 3ESCRIP7ON OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additions;Remarks Schedule,if more space is required) <br /> Certificate holder is an additional insured with respect to General Liability per written contract. <br /> CERTIFICATE HOLDER CANCELLATION <br /> (864)298-2744 mteal @greenvil_esc.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> City of Greenville ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 2207 <br /> Greenville, SC 29602 AUTHORIZED REPRESENTATIVE <br /> C Sherrill CBIA, CISR <br /> ACORD 25(2010105) 0 1988-2010 ACORD CORPORATION. All rights reserved. <br /> INW)25(7nlnn. l ni Th.dcrnrin naex¢c snri Ir aan -k.of At`npn <br />
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