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Home My WebLink AboutADECCO - INSURANCE CERTIFICATE (5),. ACORD—. �r DAT E01/02�2009 ��\y PRODUCERonRisk Insurance Services West, Inc. ATHIS on CERTIFICATE'IS ISSUED AS A -MATTER OF INFORMATION ONLY San �ranci sco CA Office - AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 199 Fremont Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1400 COVERAGE AFFORDED BY THE POLICIES BELOW. Ln San Francisco CA 94105 USA o INSURERS AFFORDING COVERAGE, NAIC # PHONE- 415 486-7000 FAX 415 486-7029 INSURED. - INSURER A: National union Fire Ins Co of Pittsburgh 19445 Adecco Inc. :~ INsiJRERB: Continental Casualty Company 20443 175 Broad Hollow Road INSURER : insurance Company of the state of PA 19429 Melville NY 11747-4902 USA ^a INSURER : American International South Ins Co 40258 INSURER : New Hampshire Ins Co 23841 -;te'rms .:an : ;con l!t ons -o. <:.:t e� 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 MAYBE 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. LIMITS SHOWN ARE AS REQUESTED INSR LTR ADD'1 INSRID TYPE OF INSURANCE - - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - LIMITS DATE(MM\DD\YY) DATE(MM\DD\YY) '4GENERAL LIABILITY GL 6506308 01/01/09 01/01/10 EACH OCCURRENCE $2 , 000, 000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $2,000,000 MADE MOCCUR N PREMISESCLAIMS ov eVersorson MED EXP (An one ne 1tb m PERSONAL & ADV INJURY $ 2 , 000 , 000 El ko GENERAL AGGREGATE $4, 000, 000 m GEN'L AGGREGATE LIMIT APPLIES PER: rV PRODUCTS - COMP/OPAGG $4,000,000 - rn O ❑X POLICY ❑ PRO- ❑ LOC O n JECT Ln A AUTOMOBILE LIABILITY CA6506167 01/01/09 01/01/10 COMBINED SINGLE LIMIT. " X -ANY AUTO - _ (Ea accident)- ...,... ,-. . -. ... 0, 000, 000 Z d - BODILY INJURY- - .... .. - .. ,. ALL OWNED AUTOS .. - cu cu SCHEDULED AUTOS .. ( Per person) -' w X HIRED AUTOS i V BODILY INJURY .X NON OWNED AUTOS (Per accident) - - PROPERTY DAMAGE • - - .-.. '. (Per accident) ._ GARAGE LIABILITY ' - - '-' AUTO ONLY - EA ACCIDENT - ANY AUTO .... OTHER THAN EA ACC H EA AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY 2227157 01/01/09 01/01/10 EACH OCCURRENCE S 5, , OCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 113LE ®DEDUC RETENTION $1,000,000 C WORKERS COMPENSATION AND 3567 C' 1 X C STATU- T RY LIMIT ER R c EMPLOYERS' LIABILITY 3566828 01/01/09 01/01/10 E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE FL D OFFICER/MEMBER EXCLUDED? 3566824 01/01/09 01/01/10 E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 E.L. DISEASE -POLICY LIMIT $2,000, 000 If yes, describe under SPECIAL PROVISIONS All other States B below 167112912 OTHER O1/01/09 Each wrongful Act $1,0( . 000 General Aggregate $1,000,000 64 Prof Liability DESCRIPTION OF OPERATIONS/LOCATIONS/VEIRCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Branch Location: Adecco Technical 4025 Automation Way Suite F1 Fort Collins, CO 80525 G1C"TIRIGATEHULi?ER ., a �" .."��' v ..... \..: • . \ CEiLATIflN' ,.. ., Y .. Cityof Fort Collins Attn : James B . O'Neill II SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N . Mason St. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Fort Collins CO 80522 USA OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Z� AUTHORIZED REPRESENTATIVE Cps �f//'� emu.�RJ�e�it�sans Attachment. to ACORDi Certifieate fur'Ade«o Inc: The terms, conditions and provisions noted -below I 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.exclusions contained in the policy. INSURED Adecco Inc. 175 Broad Hollow Road Melville NY 11747-4902 USA INSURER INSURER INSURER _..... .. _ INSURER INSURER ADDITIONAL POLICIES If a policy below. does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADD'L -- _ - - - _ -- - POLICY NUMBER .'- - POLICY - POLICY LTR- INSRD TYPE OF INSURANCE -._ POL%:.Y-DESCRIPTION EFFECTIVE - EXPIRATION LIMITS DATE DATE WORKERS COMPENSATION -- - 3566825 01/01/09 01/01/10 E CO,MI,MNNVNYSCTX 3566831 01/01/09 01/01/10 C ND,WA,WI,WV,WY 3566829 01/01/09 01/01/10 C OR OTHER 014241743 01/01/09 01/01/10 Crime A MiSC Liab Cvg Blanket Crime Coverage $1,000,000 EXCESS LIABILITY X DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No: 570032316378 e Iy� NLL .,a �� TE(0MM� D�2YYYY) DA 1 2 009 {r^1 LM PRonon ru Aon :,sk Insurance Services West, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY' ` San Francisco CA Office - - - - AND CONFERS NO RIGHTS.UPON_THE CERTIFICATE HOLDER. THIS - 199 Fremont Street CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 1400 COVERAGE AFFORDED BY THE POLICIES BELOW. Ln San Francisco CA 94105 USA "' 0 INSURERS AFFORDING COVERAGE NAIC # PHONi- 415 486-7000 FAX 415 486-7029 INSURED - INSURER A: National union Fire Ins Co of Pittsburgh 19445 INSURERB Insurance Company of the State of PA 19429 Adecco Inc. 175 Broad Hollow Road. o INSURERC: American International South Ins Co 40258 Melville NY 11747 USA M INSURERD: New Hampshire Ins Co 23841 INSURER E: a' „ 7ON \O .:.: T77.,. SIR- a 7477 . eI?- teI?lits.:ai1 :con it'ions ,of_,,t ' ' ^ .I,C . 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. LIMITS SHOWN ARE AS REQUESTED INSR ADDS INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM\DD\YY) POLICY EXPIRATIONLTR DATE(MM\DD\VY) LIMITS A GL 6506308 - 01/01/09 01/01/10 EACH OCCURRENCE $2 , 000 , 000 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F1 OCCUR DAMAGE TO RENTED PREMISES ov eperrsoso $ 2 , 000 , 000 MED EXP (An onnee n) $100,000� PERSONAL & ADV INJURY $ 2 000 000 , , GENERAL AGGREGATE $4 , 000 , 000 rrn GEN'L AGGREGATE LIMIT APPLIES PER: 0 PRODUCTS - COMP/OP AGG $4 , 000 , 000 ❑X POLICY ❑ PRO- ❑ LOC JECT Ln A ' AUTOMOBILE LIABILITY CA6506167 01/01/09 01/01/10 COMBINED SINGLE LIMIT - p X ANY AUTO'.. - (Ea accident) _ - $ 2 , 000,000 Z BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS ( Per person)— -- L X HIRED AUTOS BODILY INJURY - .. V X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) - GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ._.. ANY AUTO OTHER THAN EA ACC H AUTO ONLY: AGG A EXCESS [UMBRELLA LIABILITY 2227157 01/01/09 01/01/10 EACH OCCURRENCE $5,000,000 ElOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 ®DEDUCTIBLE RETENTION $1,000,000 B 3 5 6 77— 01/01/09 X WC STATU- I OTH- WORKERS COMPENSATION AND CA T RY LIMITS ER —_ E.L. EACH ACCIDENT $2,000,000 B EMPLOYERS'LIABILITY 3566828 01/01/09 01/01/10 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FL E.L. DISEASE -EA EMPLOYEE $ 2 , 000 , 000 G 3566824 01/01/09 01/01/10 E.L. DISEASE -POLICY LIMIT $ 2 , 000 , 000 If yes, describe under SPECIAL PROVISIONS below AOS - OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEFHCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Branch Location: Adecco Engineering & Technical, 4025 Automation way F1, Fort Collins, Co 80525. CERTIFICATE HOLDER �� C, 'w City Of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn : James B. O'Neill II DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N . Mason St. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, r� Fort Collins CO 80 522 USA BUT OF FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 91.1 q//�� 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 exclusions contained -in -the policy. INSURED Adecco Inc. ..175 Broad Hollow Road Melville NY 11747 USA INSURER INSURER INSURER _. ......._ ... .. INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. R LT R ADD'L INSRD - TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE - POLICY EXPIRATION DATE - LIMITS • - WORKERS COMPENSATION D 3566825 CO,MI,MNNVNYSCTX 01/01/09 01/01/10 B 3566831 ND,WA,WI,WV,WY 01/01/09 01/01/10 B 3566829 OR 01/01/09 01/01/10 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570032319504