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HomeMy WebLinkAboutADECCO - INSURANCE CERTIFICATE (3).1.........,.�_..... __.-�^° , _ . ,�.„ a 1 , .p_ ag uy !a i,n t Lao, 1 . ,_ I I ACOR'D'- CERTII+I ATE_OF"LIABILITY IN rRA ' i °`°"°":' ''=" b DATE12/31/200YY� C P, SL iYCEt;; , : t ;'r: E, _ _ /31/2007I A ruooucca Aon Risk services, Inc of Northern CaliforniaTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 199 Fremont Street AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS Suite 1400 CERTIFICAI E DOES NOT AMEND, EX FEND OR ALTER THE San Frdncl sco CA 94105 USA COVERAGE AFFORDED BY THE, POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC# PHONE 415 486-7000 FAX 415 486-7029 INSURED INSURER National Union Fire Ins Co of Pittsburgh 19445 Adecco Inc 175 Broad Hollow Road INSURERS Insurance Company of the state of PA 19429 INSURER American Home Assurance Co 19380 Melville NY 11747-4902 USA INSURER Illinois National Insurance Co 23817 INSURER Continental Casualty Company 20443 ,_ t, 1t S[Rn Ma iiA THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQLJIRE1NENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TA7 S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TMb TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR ADD I INSRB IVPEOFINMJRANCE POLIO\ NUMBER POLICY EFFECOVI DAT (NINEDD6N POI ICY LAPIRATIDN DATAIM\DDO\) I LIMITS A WNERALuaaRnY 1595722 01/01/08 01/01/09 EACH OCC URRENCF $2,000,000 )( COMMERCIAL GENERAL LIADILI I Y DAMAGE FORESCED $2,000,000 CLAIMSMADE M OCCUR PREMISFSILaocwrence) MED M IAm one pe[sonl 1 PERSONAL &ADV INJURY $2,000,000 ❑ GENERAI AGGREGATE $4,000,000 GENL AGGREGATE LIMIT APPLILS PER PRODUC IS-COl1VtOP AGG $4, 000, 000 +OLICY ElPRO11 In IOC ILCTL1 A A U I OMOB I LE LIA BBLITY 1607274 01/01/08 01/01/09 COMBINED SINGLF L]MIT X NNY AUTO iFa accident) $2,000,000 ILL OWFFD AM OS IJODILY INJURY }CHI DULED AUTOS Per person) HIRED AMOS X BODILY INJURY X NON OWNLD AUTOS IPerewlde n PROPERTY DAMAGE (Per accident) CARAGI LIABILITY AU TO ONL\ -EA ACCIDENT ANY AID DiIIER THAN EA ACC e AUTO ONLY AGL A LYCEsraNITHRELLA LIABHI Y 9835490 01/01/08 01/01/09 EACH o((URRENCL ,ME OCCUR El CLAIMS MADE PGGREGATE $5,000,000 DI VU(TIBLE - PCIENTION $1,000,000 a C C N ORRIN RS COMPENSA I ION AND EMPLOYERS' I (ABILITY ANY VItOPRIETOR/PARTNER /EXECU LIVE OFFICER/MIABEREXCIUDCD1 5145042 CA 5145043 FL 7 1 01/01/08 Ol/Ol/OS 01/01/09 01/01/09 y WC SIATU- TOR V I IMHS I OTH FR fI EACH ACCIDENT $2, OOQ, 000 E L DISFASL LA PION OYLE $2,000,000 F L DISEASE-POLICYIIMIT $2,000,000 Ifues de,enbe under SPLCIAI PROVISIONS AllAlj other StdtBS below E OTOTHER01 Prof uablltty 167112912 01/01/08 1 each wrongful Act $1,000,000 General Aggregate $1,000,000 DESCRIPTION OF OPI RATIONS/LOCATIONSATI III I ES/EXCLUSIONS ADDED BV ENDORSEMI Ni /SPECIAL PROVISIONS Branch Location Adecco Technical 4025 Automation Way Suite F1 Fort Collins, C0 80525 CERTIFICATE HOEDER'' 'I}:m, .' ,; �` a r CANCELLATION., City Of Fort Collins ATTN 39ME-5 B O'Neill II SHOULD ANY 01 11 IF ABOVE OI SCRIBED POLICII S BE CANCELI 1 D BEFORE THE EXPIRATION DATE I I II BLOT THE ISSUING INgURI R WILL ENDEAVOR TO MAIL 215 N Mason St Fort Collins CO 80522-0580 USA 30 DAYSWRIIILNNOTICFiO1HE(CRTIFICAFE HOLDER NAMED TO THE LEFT BUT FAII URE TO DO SO SI(ALL IMPOST NO OBLIGATION OR LIABILDY OF ANY KIND UPON I I IL INAIRT R I I S AOENTS OR RY PRESENTATD PS AUHHORIZEDREI'RPSINTATIVE A ORD 25 20�D11081 6 -,`,, II; . ='S" t., Pe, ACOREUCORPORATION198 Attachment to ACORD Certificate for Adecco Inc The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s) This attachment does not contain all terms, conditions, coverages or e%clusmns contained in the policy INSURLD Adecco Inc 175 Broad follow Road Melville NY 11747-4902 USA ADDITIONAL POLICIES If a policy below does n INSURER INSURER INSURER INSURER INSURER of mLlude limit information, refer to the corresponding policy on the ACORD certificate form for policy limits INhR LIR At) DL JNSRII TI PE OF INSIIRANCL POLICI MINIM POI 10 DESCRIPTION POI ICN IISR 11111 ' POI ICI A FXP,RTEION LIMI IS WORKERS COMPENSATION D 5145046 CO,MI,MNNVNYSCTX 01/01/08 01/01/09 C 5145045 ND,WA,WI,WV,WY 01,/01/08 01/01/0'3 C S14SO44 OR O1/O1/08 O1/01/09 OTHER A MiSC Liab Cvg 005466805 Blanket Crime 01/01/08 01/01/09 Crime Coverage $1,000,000 EXCESS LIABILITY X DLSCRIP I ION Of OPERA9 IONS/I OCATIONYVFHICLES/F%C1 USIONS AUDI Il BY PNDORSEMCNT/SPECIAL PROVISIONS Certificate No • 570026538140 ACORD,. „Ni ” - , Y x 1 'CERTIFICATE OF LIABILITY INSURANCE' " Il 1 z DATE(MM/DD/YY") 12/31/z0W PRODUADDCERRisk Services, Inc of Northern California THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 199 Fremont 99 Fremont Street AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS Suite 1400 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE San Francisco CA 94105 USA COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIL# PHONE 415 486-7000 PAX 415 486-7029 INSURED INSURER National Union Fire Ins Co of Pittsburgh 19445 Adecco Enc 175 Broad Hollow Road INSURER Insurance Company of the State of PA 19429 INSURLRC American Home Assurance Co 19380 Melville NY 11747-4902 USA NS1_RFR1) I111 ols National Insurance Co 23817 INSUREBr Continental casualty company 20443 VFWk FS ', SIR, Ma A THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE I OR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPLCI TO WHICH THS 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ISSUE I I R ADD L INSRII II PC OF INSURANCE POI ICI NUMBER POI ICI I PFLCOIN E DATE(MM\DD\il) POLICE LXPIRAI ION DAT1(MABDD\l9) LIMITS A NIERAL LIARR ITY 1595722 01/01/08 01/01/09 FACE] OCCURRFNCF $2,000,000 DAMAGE TO BEN OLD $2,000,000 X COMNERCIAI GENERAL LIABII ITY CLAIMS MADE © OCCUR PRT MISESAn, oaenen. INE rence) MLD Inn. ocw 1 PLRSONAL&ADV INJURY $2,000,000 GI NERAL AGGRI GATE $4,000,000 GINI kGGRLGAIL LIMIT APPLILS PER ❑ POI ICY ❑ O ❑ LOC PRODUCTS COMP/OP AGO $4,000,000 J ECT A AUIOMOBILF IIABILIII 1607274 01/01/08 01/01/09 COMBINED SINGLE LIMIT X ANYAUTO (Enecuden) $2,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUI OS ( Per person) X HIRFD AUTOS BODILY INJURY X NON OWNED AUI OS Per aemdeoq PROPERn DAMAGE mu aeedenp CARACF LIABILITI AUFOONLY EAACCIDEN'1 AN) AUTO I Y EA ACC B AUTO AUTO ONLY AGG A FXCISSNMBRELLA I IARILITI 9835490 01/01/08 01 O1 09 LACH OCCURRENCE ,CIOU ElOCCUR 1:1 CLAIMSMADF AGGRFGATE $5,000,000 DI DUCTIBLE RI TCNTION S1,000,000 B C WORM RS(OMPFNNA [ION AND EMP1OIFRS'LIABII In ANl PROPRIETOR/PARTNER/EXECUTIVE OrrICE]UMEMBER EXCLUDED' 5145042 CA 5145043 FL S145047 01/01/08 01/01/08 01/01/09 01/01/09 X WC STATI]- F RYI EMTIC OTH R EL IACT I ACCIDENT 12,000,000 LL DISEASE LA LNIPLOYEE $21,000.000 El DISLASE-POLICY LIMIT $2,000,000 Ifyes desenbe under SPECIAI PROVISIONS belnw All other states E OTIIf R Prof liability 167112912 01/01/08 1 Each wrongful Act $1,000,000 General Aggregate $1,000,000 DESCRIPTION Od OFF RAOIONS/I OCAHONSIVEHICLESA XCI USIONS ABBE D BY ENDORM MLNTISPECIAI PROVISIONS Branch Location Adecco Technical 4025 Automation way Suite F1 Fort Collins, CO 80525 CERTIFICATE HOLDER CANCELLAI ION' City of Fort Collins ATTN lames B O'Neill IT DATF M10ULDANY01TIIEABOVIINNCRIBFDPOLICILS III CANCLLLLD BE FURL IHEEXPIRAFION TIIERLOI I I ISSUING INSURLR WILL I N'IILAVORTO MAII 215 N Mason St 10 Fort Collins CO 80522-0580 USA BUT OF DAYS WRIT I I N NOIICETO]HE CPRIIFICArc HOE DFR NAMED 101116LE1T FATLURLIO DO SO SHALL IMPOSENO OBI IGAIIONOR LIABILITY ANY KIND UPON THE INSURE R ITS AGEVI S OR REPRESENTAnVES AUTHORI7I D RI PRESENTATIVE- ACORD 25 I01O V084 . ' , . " ` , I - A T 9 Attachment to ACORD Certificate for Ad.cco Inc The term,, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the msurer(s) This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy INSURED Adecco Inc 175 Broad 11011OW Road Melvllle NY 11747-4902 USA ADDITIONAL. POLICIES If a policy below does n INSURER INSURER INSURER INSURER INSURER of include limit information, refer to the corresponding policy on the ACCORD certificate form for policy limits INSR ITR ADn'L INSRD TYPE OF INSURANCE POLICY NUMDFR POI ICI DESCRIPTION POl ICY EFFECTIVE DAIE POLICY EXPIRATION DAIL LIMAS WORKERS COMPENSATION D 5145046 CO,MI,MNNVNYSCTX 01/01/08 O1/O1/09 C 5145045 ND,WA,WI,WV,WY 01/01/08 01/01/09 C 5145044 OR 01/01/08 01/01/09 OTHER A _ MISC Llab Cvg 005466805 01/01/08 01/01/09 Crime Coverage $1, 000, OOD DESCRIPTION OF OPERATIONS/ OCA I IONS/VEHICI P9LXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No 570026538820