Orange County NC Website
Browse       Search
AGENCY CUSTOMER ID: <br />ADDITIONAL REMARKS SCHEDULE <br />LOC #: <br /> ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance <br />EFFECTIVE DATE: <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSUREDAGENCY <br />See Certificate Numbe <br />See Certificate Numbe <br /> 570085997319 <br /> 570085997319 <br />Aon Risk Services South, Inc. <br /> 570000019132 <br />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />INSURER(S) AFFORDING COVERAGE <br />Page _ of _ <br />NAIC # <br />Randstad Professionals US, LLC <br /> TYPE OF INSURANCE <br />POLICY NUMBER LIMITS <br />WORKERS COMPENSATION <br />A WLRC67457602 10/01/2020 10/01/2021 <br />OTHER <br />D ERISA Bond P00100020901202 10/01/2020 10/01/2021 Client <br />Coverage Amt <br />$5,000,000 <br />WC - MA & CA <br />Crime-Client Property <br />N/A <br />ADDL <br />INSD <br />INSR <br />LTR <br />SUBR <br />WVD <br />POLICY <br />EFFECTIVE <br />DATE <br />(MM/DD/YYYY) <br />POLICY <br />EXPIRATION DATE <br />(MM/DD/YYYY) <br />SIR applies per policy terms & conditions <br />ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />DocuSign Envelope ID: DF2096E5-0587-4098-9E28-4618EE074BD2DocuSign Envelope ID: E1B078A6-EFC2-4935-B98B-D38AF4BEDBB7