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Home My WebLink AboutADECCO - INSURANCE CERTIFICATE (4)A CORD.M , CERTIFICAT�E-60F DATE(MM/DD/YYYY) 1ABILITY I#NSTIRANCE ... i 05/11/2009 j PRODUCER Aon Risk 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 1500 COVERAGE AFFORDED BY THE POLICIES BELOW. San Francisco CA 94105 USA 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.... 175 Broad'Hollow Road INSURERB: Insurance Company �of the 'State of PA 19429 INSURER : American International South Ins Co 40258 Melville NY 11747-USA INSURERD: New Hampshire Ins Co 23841 INSURER E: l v ,r 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 LTR ADD'1 INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM\DD\YY) POLICY EXPIRATION DATE(MM\DD\YY) LIMITS A GENERAL LIABILITY X CONIMERCIAL GENERAL LIABILITY GL6506308 01/n/09 01/01/10 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $2 , 000 , 000 CLAIMS MADE ® OCCUR PREMISES (Ea occurence) M D EXP (Anv one person) 1 0, PERSONAL & ADV INJURY $2 , 000, 000 ❑ GENERAL AGGREGATE $4, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ ❑X LOC JECT PRODUCTS - COMP/OP AGG $4, 000, 000 A AUTOMOBILE LIABILITY CA 65061 67 01/01/09 01/01/10 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 2 , 000 , 000 ALL OWNED AUTOS • BODILY INJURY- - - - -• SCHEDULED AUTOS ( Per person) X HIRED AUTOS 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 AUTO ONLY AGG A EXCESS [UMBRELLA LIABILITY 2227157 01/01/09 01 01 10 EACH OCCURRENCE $5,00 ElOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE RETENTION B B WORTCERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE CA 3566828 FL 01/01/09 01/01/10 X WC STATU- TORY LIMITS OT OTH- ER —_ E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 ,d $2 , 000, 000 C OFFICER/MEMBER EXCLUDED? Ifyes, describe under SPECIAL PROVISIONS below 3566824 ADS 01/01/09 01/01/10 E.L. DISEASE -POLICY LIMIT �1 OTHER i1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Branch Location: Adecco Engineering & Technical, 4025 Automation way F1, Fort Collins, Co 80525. CERTIFICATE HOLDER=<. CANCELLATION' ' Cityof Fort Collins Attn: Ed Bonnette SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION e� DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 N . Mason St. Fort Collins CO 80522 USA 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 REPRESENTATIVES. s-` AUTHORIZED REPRESENTATIVE uqva y raj f• p Q L� C.QG a o1//`� ✓u�st✓ c/ lYe� __ �„ ACORD 25 2001/08 = �. ' :'""' ' F ,.:_" _, . ACORD CORPORATIOI988 n tb lD tb M V M O O n Ln 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. INSR I - LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS WORKERS COMPENSATION 356682S CO3MI;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 : 570034386876