2017-537-E ES - ESO Solution, Inc. for EHR billing software

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DocuSign Envelope ID:5217DEC1-2EF1-4A49-AD1F-F6CBCC3F8A9E AIG-BJD Adoa Rm CERTIFICATE OF LIABILITY INSURANCE YYY) 9/2 MIDD/Y M/DD/Y DATE(M 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 NAME: Risk Management Department Commercial Lines-(305)443-4886 PHONE FAX (A/C,No,Ext) (866)443-8489 (A/C,No): (800)889-0021 Wells Fargo Insurance Services USA, Inc. E-MAIL C k or . om ADDRESS: Work.Comp@Trinet.com 2601 South Bayshore Drive,Suite 1600 INSURER(S)AFFORDING COVERAGE NAIC# Coconut Grove, FL 33133 INSURERA: Indemnity Insurance Company of North America 43575 INSURED INSURER B: TriNet HR III,Inc. INSURER C: RE: Eso Solutions Inc INSURER D: 9000 Town Center Parkway INSURER E: Bradenton, FL 34202 INSURER F: COVERAGES CERTIFICATE NUMBER: 12286627 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 (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE RETED CLAIMS-MADE OCCUR PREMISES O(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY 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) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ $ A WORKERS EMPLOYERS'COMPENSATION WLRC64417861 7/1/2017 7/1/2018 X STATUTE EERH AND EMPLOYERS'LIABILITY 2,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT OFFICER/MEMBEREXCLUDED? N 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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation coverage is limited to worksite employees of Eso Solutions Inc through a co-employment agreement with TriNet HR III,Inc. CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Link Government Services Center ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)