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Home My WebLink AboutADECCO USA - INSURANCE CERTIFICATE (2)DATE ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/31/032/31/03 YY) 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 os,h! 77e528�1690017 INSURERS AFFORDING COVERAGE 56 INSURED INSURER A:National Union Fire Ins. Co. of Pittsburgh, PA Adecco USA, Inc. INSURER B:2navrance Company of the State of Pennsylvania 175 Broadhollow Rd. INSURER C: Illinois National Insurance Co. lNelville, NY 11747 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. B18R TYPE OF INSURANCE POLICY NUMBER POLICY nATF mtoor WE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR 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 8 ADV INJURY $ 2, 000, 000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 51 POLICY I PRO- 71 LOG PRODUCTS-COMP/OP AGG $4, 000, 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA 5288618 01/01/04 01/01/05 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 X BODILY INJURY (Per person) $ X BODILYINJURY (Per accident) $ X PROPERTY DAMAGE (Per eccident) $ GAR AGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ p+ EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ SE2860588 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 OR STATU- OR E.L. EACH ACCIDENT $ 2, 000,000 E.L. DISEASE - EA EMPLOYEd $2,000,000 E.L. DISEASE -POLICY LIMIT I $ 2, 000, 000 D E OTHER Professional Liability (E40) FIDELITY BOND (Crime) 167112912-05 JCCR 400011804 01/01/04 1 01/01/04 01/01/05 1 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 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 Collins, CO 80522 USA ACORD 25-S (71971 imaonsf 1563412 AUTHORIZED REPRESENTATIVE SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE 12/31/03 Adecco USA, Inc. Certificate Addendum Workers Compensation and Employers Liability Carrier (AOS Non -Dad): American Home Assurance Company Policy Number: WC 2981587 (AOS Non-Ded) Policy Term: 01/01/2004 to 01/01/2005 WC 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