Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutVOLT INFORMATION SCIENCES INC - INSURANCE CERTIFICATE (3)ACORe CERTIFICATE OF LIABILITY INSURANCE
DATE 03125/2011 YVVY)
2011
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 endomement(s).
PRODUCER
Marsh USA, Ifm.
1166 Avenue of the Americas
CONTACT
NAME:
PHONE ac No:
E-MAIL
New York, NY 10036
Alin: NewYorkCWs@Marshoom Fax: 212-94H500
PRODUCER
CUSTOMER 10 N.
572750-CAS-GAWU-11-12 ADDTL
INSURERS AFFORDING COVERAGE
NAIC r
INSURED
INSURER A: National Union Fife Insuranoe Company
19445
VOLT INFORMATION SCIENCES, INC.
ATTN: GARY G.PENEBRE
1065 AVENUE OF THE AMERICAS, 20TH FLOOR
INSURER e: Illinois National Ins Go
23817
INSURER C : New Hampshire Ins. Go.
23841
NEW YORK, NY 10018
INSURER o: St. Paul Fire 8 Manna Ins Co
24767
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: NYC 004489580-23 REVISION NUMBER: 5
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
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MMIDO/YYYY
POLICY EXP
MM IDD/YVYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FT] OCCUR
440-62-86
03131/2011
03/31,2012
EACH OCCURRENCE
$ 1,000,000
DAMA T R NT D
PREMISE Ea occurrence
$ 250'000
MED EXP (Any one person)
$ 10,000
PERSONAL S ADV INJURY
$ 1.000.000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X I POLICY E PRO- LOG
PRODUCTS - COMP/OP AGO
$
$
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OVMED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
430-94-19(ADS)
430-94-50(VA)
03/31/2011
03/31/2011
03/312012
03/312012
COMBINED SINGLE LIMIT
(Ea accidem)
$ 1000000
X
BODILY INJURY (Par person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
S
D
X
UMBRELLA DAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
OK09002319
03/31/2011
031312012
EACH OCCURRENCE
$ 5,OD0,000
AGGREGATE
$ 5,000,000
DEDUCTIBLE
I RETENTION $ 10,000
$
X
$
A
A
B
G
MRKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXEClII1VE Y�
O anclat ry in N )EXCLUDED?
(Mandatory in NH)
If yes.
DESCRI TION OF OPERATIONS helox
NIA
061967447(ADS)
061967448(CA)
061967449 (FL)
061967450 (TX)
03/31/2011
03/312011
03/31/2011
03/31/2011
03/312012
B3/312012
03012012
031312012
X VJCSTAru- OTH-
LLMIT
E.L. EACH ACCIDENT
$ 1.00m
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
1 E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
W/C CONT.
(MA,ND,NY,OH,WA,WI,WY)
061967451(MA,ND,OH,WA,WI,WY)
03012011
M12012
SEE ABOVE FOR LIMITS
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Affech ACORD 101, Additional Remarks Schedule, If more space is required)
THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED UNDER THE GENERAL AND AUTOMOBILE LIABILITY POLICIES WITH RESPECT TO
SERVICES PERFORMED BY VOLT,
CITY OF FORT COLLINS
ATTN: JAMES B. O'NEIL
215 NORTH MASON STREET
FORT COLLINS, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Sue Srinivasan
© 1988.2009 ACORD CORPORATION. All riahts
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
ACORe CERTIFICATE OF LIABILITY INSURANCE
DATE 03125/2011 YVVY)
2011
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 endomement(s).
PRODUCER
Marsh USA, Ifm.
1166 Avenue of the Americas
CONTACT
NAME:
PHONE ac No:
E-MAIL
New York, NY 10036
Alin: NewYorkCWs@Marshoom Fax: 212-94H500
PRODUCER
CUSTOMER 10 N.
572750-CAS-GAWU-11-12 ADDTL
INSURERS AFFORDING COVERAGE
NAIC r
INSURED
INSURER A: National Union Fife Insuranoe Company
19445
VOLT INFORMATION SCIENCES, INC.
ATTN: GARY G.PENEBRE
1065 AVENUE OF THE AMERICAS, 20TH FLOOR
INSURER e: Illinois National Ins Go
23817
INSURER C : New Hampshire Ins. Go.
23841
NEW YORK, NY 10018
INSURER o: St. Paul Fire 8 Manna Ins Co
24767
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: NYC 004489580-23 REVISION NUMBER: 5
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
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MMIDO/YYYY
POLICY EXP
MM IDD/YVYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FT] OCCUR
440-62-86
03131/2011
03/31,2012
EACH OCCURRENCE
$ 1,000,000
DAMA T R NT D
PREMISE Ea occurrence
$ 250'000
MED EXP (Any one person)
$ 10,000
PERSONAL S ADV INJURY
$ 1.000.000
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X I POLICY E PRO- LOG
PRODUCTS - COMP/OP AGO
$
$
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OVMED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
430-94-19(ADS)
430-94-50(VA)
03/31/2011
03/31/2011
03/312012
03/312012
COMBINED SINGLE LIMIT
(Ea accidem)
$ 1000000
X
BODILY INJURY (Par person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
S
D
X
UMBRELLA DAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
OK09002319
03/31/2011
031312012
EACH OCCURRENCE
$ 5,OD0,000
AGGREGATE
$ 5,000,000
DEDUCTIBLE
I RETENTION $ 10,000
$
X
$
A
A
B
G
MRKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXEClII1VE Y�
O anclat ry in N )EXCLUDED?
(Mandatory in NH)
If yes.
DESCRI TION OF OPERATIONS helox
NIA
061967447(ADS)
061967448(CA)
061967449 (FL)
061967450 (TX)
03/31/2011
03/312011
03/31/2011
03/31/2011
03/312012
B3/312012
03012012
031312012
X VJCSTAru- OTH-
LLMIT
E.L. EACH ACCIDENT
$ 1.00m
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
1 E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
W/C CONT.
(MA,ND,NY,OH,WA,WI,WY)
061967451(MA,ND,OH,WA,WI,WY)
03012011
M12012
SEE ABOVE FOR LIMITS
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Affech ACORD 101, Additional Remarks Schedule, If more space is required)
THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED UNDER THE GENERAL AND AUTOMOBILE LIABILITY POLICIES WITH RESPECT TO
SERVICES PERFORMED BY VOLT,
CITY OF FORT COLLINS
ATTN: JAMES B. O'NEIL
215 NORTH MASON STREET
FORT COLLINS, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Sue Srinivasan
© 1988.2009 ACORD CORPORATION. All riahts
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD