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Home My WebLink AboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCE CERTIFICATE 2004ACORDCERTIFICATE OF LIABILITY INSURANCE DATE(MLWDYY) 12/31/03 PRODUCER LIC #0363334 1-866-283-7123 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ann Risk Services Inc. of Southern CA. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Document Production Unit HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Attn. Johnnie McKinley ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 707 Wilshire Blvd., Suite 6000 Los Angeles, CA 90017 Fax-877-528-1656 INSURERS AFFORDING COVERAGE INSURED Adecco USA, Inc. INSURER A: National Union Fire Ins. Co. of Pittabur h PA INSURER B: Insurance Company of the State of Pennsylvania 175 Broadhollor Rd. INSURER C: Illinois National Insurance Co. INSURER D: Columbia Casualty Company Melville, NY 11747 INSURERE:Quanta Reinsurance U.S. Ltd. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMM/DD1YY1 POLICY EXPIRATION.LTJL DATE IUUMD/YYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FKOCCUR GL 4806040 01/01/04 01/01/05 EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE (Any one fire) $2,000,000 MED EXP (Any oneperson) $ 100, 000 PERSONAL B ADV INJURY $2,000,000 GENERAL AGGREGATE $ 4,000,000 GE] -NI AGGREGATE LIMIT APPLIES PER: rX POLICY PRO- LOC PRODUCTS-COMP/OP AGG $4, 000, 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA 5188618 01/01/04 01/01/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ BE2860588 01/01/04 01/01/05 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5, 000, 000 $ $ B C C B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 2981552 (CA) WC 2981586 (NY) WC 2981553 (IL) WC 2981551 (AOS) 01/01/04 01/01/04 01/01/04 01/01/04 01/01/05 01/01/05 01/01/05 01/01/05 X WC STATU- OTORY LIMITS TH- E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYE $2,000,000 E.L.DISEASE-POLICY LIMIT $2,000,000 D E OTHER Professional Liability (ESO) IFIDELITY BOND (Crime) 167212912-05 ICCR 400011804 01/01/04 01/01/04 01/01/05 01/01/05 Each Wrongful Act 1,000,000 General Aggregate 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Fort Collins James O'Neil II - CPPO, FNIGP 215 North Mason Street, 2nd Floor Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE USA ACORD 25-S (7197) jmaonsf O ACORD CORPORATION 1988 SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE 12/31/03 INSURED: Adecco USA, Inc. Certificate Addendum Workers Compensation and Employers Liability Carrier (ADS Non -Dad): American Nome Assurance Company Policy Number: NC 2981587 (AOS Non-Ded) Policy Term: 01/01/2004 to 01/01/2005 NC Statutory Limits E.L. Each Accident: $2,000,000 E.L. Disease -Policy Limit: $2,000,000 E.L. Disease -Each Employee: $2,000,000 SUPP