2015-363-E HR - Flores & Associates, LLC - Medical Reimbursement and Dependent Care Assistance Claim Administration Agreement

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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 � �)CERTIFICATE F LIABILITY INSURANCE �2l��io� 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 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 Cindy Sherrill CBIA CISR NAM.-: First Citizens Insurance Services PHaNE ;. (704)338-3837 1 FAC N.. (366)578-4503 P O Box 29611 E-MAIL AODRESS:rind y.sherrill @fisstcitizens-coaaL INSURER(S)AFFORDING COVERAGE NAIL# Raleigh NC 27626-0611 INSURERA:Sentinel Ins Co, LTD 11000 INSURED INSURER B:Ha.rtford Ins Co of Midwest 37478 Flores & Associates LLC INSURER c:Federal. Insurance CqTpany 20281 PO Baas 31397 INSURER D: INSURER E Charlotte NC; 28231 INSURER r COVERAGES CERTIFICATE NUMBER:14-15 Master COI 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 ANE CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ENSR I TYPE OF INSURANCE INSR 5U POLICY LTR D POLICY NUMBER MMIGD?YYYY MMDDIYYYY LIMITS GENERAL LIABILITY FACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIAB'�LIlY $ DAMAGE TO RENTED 1,000,000 PREMISES Eacccunence A C[AIMS-MA.DF 7X OCCUR X 228BAZG3564 661/2014 6/1,12015 NiFDFXP(Any ore F:erscm) $ 10,000 PERSONAL&r1DVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIV T APPLES PER. PRODUCTS-COMP OP AGG $ 2,000,000 ----- ------ ----- ------------------------------------------------------------------------ X POLICY F•R.t I_C1C $ AUTOMOBILE LIABILITY COIL NED SINGL.E LIVIT ANY AUTO BODILY'INJURY(Per person) $ All_OLtiNED SCHEDULED BODILY INJURY(Pcr accident) $ AUTOS AUTOS NCJN-DVVKrD PROPERZDAMAGE $ H IRFCI AUTOS AUTOS FP.r acrid©nt X UMBRELLA LIAB OCCUR 28BAZG3564 8/1/2014 8/112015 EACH OCCURRFNCF $ 1,000r Q00 A EXCESSLIAB GLAIMS-MADE AGGREGATE $ 1,000,000 DFD I I RFTFNTON 10,03 $ B WORKERS COMPENSATION X AIC STATU- UTH- AND EMPLOYERS'LIABILITY Y f N ANY PRCPRFTCRlPARFNFWEXFCUT IVF F7N NIA E.L.EACH ACCIDENT $ 500 000 OFI=l CFF2JMEh1ELR EXCLUL`I=6? tY° B�r,g76S6 8j1/2014 8f112015 (Mandarcry in NH) EL FT,,FAaF-FA EPAPLOYE $ .100 000 If yes.describe wider DESCRIPTION OF OPERATIONS 6dow E.L.DISEASE-P'0L LIMIT $ 500 000 lird Party Crime 2 TP 0267837 15 01/01/2015 01/01/2016 $1,000,000 Limit $25,000 De emises Greenville, Sr 3ESCRIP7ON OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additions;Remarks Schedule,if more space is required) Certificate holder is an additional insured with respect to General Liability per written contract. CERTIFICATE HOLDER CANCELLATION (864)298-2744 mteal @greenvil_esc.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Greenville ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2207 Greenville, SC 29602 AUTHORIZED REPRESENTATIVE C Sherrill CBIA, CISR ACORD 25(2010105) 0 1988-2010 ACORD CORPORATION. All rights reserved. INW)25(7nlnn. l ni Th.dcrnrin naex¢c snri Ir aan -k.of At`npn