The URL can be used to link to this page

Home My WebLink AboutADECCO USA - INSURANCE CERTIFICATEA RD. CERTIFICATE OF LIABILITY INSURANCE DATE (NIII YY) 07/01/04 PRODUCER LIC #0363334 1-866-283-7123 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Aon 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 Ina. CO. Of Pittsburgh, PA INSURER s: Insurance Company of the State of Pennsylvania INSURER C: Illinois National Insurance Co. 175 Broadhollow Rd. INSURER D: Columbia Casualty Compare Melville, NY 11747 INSURER E: anta 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 (MMIDDrfY) POLICY EXPIRATION DATE (MMfDDNY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE T OCCUR GL 4806041 07/01/04 01/01/05 EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE (Anyone fire) $ 2,000,000 MED EXP (Any one person) $100,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $4,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS CA 5188815 07/01/04 01/01/05 COMBINED LIMIT (Ea accident) $1,000,000 g 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/OS EACHOCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 $ $ B C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY See attached addendum WC 5212852 (CA) WC 5212854 (NY) WC 5212853 (IL) 07/01/04 07/01/04 07/01/04 01/01/05 01/01/05 01/01/05 OTH- X WC LIMITS EEL E.L. EACH ACCIDENT $ 2, 000, 000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $ 2, 000, 000 D E OTHER PROFESSIONAL LIABILITY (H & O) FIDELITY BOND (CRIME) 167112912-05 CR 400011804C 01/01/04 01/01/04 01/01/05 01/01/05 Each Wrongful Act 1,000,000 General Aggregate 1,000,000 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS nvILvcn I I ADDITIONAL City of Fort Collins James O'Neil II - CPPO, FNIGP 215 North Mason Street, tad Floor 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 Fort Collins, CO 80522 USA ACORD 25-S (7/971 imaonsf 1945240 AUTHORIZED REPRESENTATIVE Qi _i / 5� rrl SUPPLEMENT TO CERTIFICATE OF INSURANCE 07DATE /O1/04 NAME OF INSURED: Adecco USA, Inc. Additional Description of Operations/Remarks from Pace 1: Add Riona I Information: Workers Compensation and Employers Liability: Carrier (AOS Non-Ded): American Home Assurance Company Policy Number: NC 5212855 (AOS Non-Ded) Policy Term: 07/01/2004 to 01/01/2005 WC Statutory Limits: E.L. Each Accident: $2,000,000 E.L. Disease -Policy Limit: $2,000,000 B.L. Disease -Each Employee: $2,000,000 Workers Compensation and Employers Liability: Carrier (AOS ): American Home Assurance Company Policy Number: WC 5212851 (AOS) Policy Term: 07/01/2004 to 01/01/2005 WC Statutory Limits : E.L. Each Accident: $2,000,000 H.L. Disease -Policy Limit: $2,000,000 H.L. Disease -Hach Employee: $2,000,000 ON