HomeMy WebLinkAbout114084 EXPRESS PERSONNEL SERVICES - INSURANCE CERTIFICATE (2)ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
8/11/2009
PRODUCER Phone: 800-888-3910 Fax: 312-527-9473 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Hilb Rogal & Hobbs (HRH) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
One East Wacker Drive, Suite 1800 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Chicago IL 60601
INSURERS AFFORDING COVERAGE I NAIC #
INSURED INSURER A: National Union Fire Insurance
Express Services, Inc. INSURER B: Insurance Company of the Stat
8516 NW Expressway INSURERC:Illinois National Ins. Com an
Oklahoma City OK 73162
INSURER D:
INSURER E:
nnVFRAnFS
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
LTR
ADDI
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
X
GENERAL LIABILITY
SSL9518899
10/1/2008
10/1/2009
EACHOCCURRENCE
$ 5 00p 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE In l OCCUR
PREMISES Ea occurence
$ 2 5 0 0 0 0
MED EXP (Anyone person)
$ 5 0 0 0
PERSONAL& ADV INJURY
$Included
X Stuffing St-rvicP
GENERALAGGREGATE
$ 5 000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OPAGG
$ Included
X POLICY PRO LOC
JECT
A
X
AUTOMOBILE
LIABILITY
ANY AUTO
SSL9518899
10/l/2008
10/l/2009
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 0 0 0, 0 0 0
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
GARAGELIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
X
EXCESS/UMBRELLALIABILITY
X I OCCUR CLAIMS MADE
5474999
10/1/2008
10/1/2009
EACH OCCURRENCE
$ 10 000 000
AGGREGATE
$ 1O 00O 000
$
DEDUCTIBLE
$
RETENTION $
B
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
4800771
'S F'F-' ATTACHED LIST
10/1/2008
10/l/2008
10/1/2009
10/1/2009
X TORY WCS IMT OR
E.L. EACH ACCIDENT
$ 1 0 0 0 0 0
E.L. DISEASE - EA EMPLOYEE
$ 1 0 0 0 0 0 0
SPECIAL PROVISIONS below
E. L. DISEASE -POLICY LIMIT
$ 1 0
p
A
OTHER
Crime/Fidelity
Staffing E&O Coverage
1757787
SSL9518899
10/1/2008
10/l/2008
10/l/2009
10/l/2009
rime/Fidelity $1,000,000
&O Occ/Agg $5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
11 insurance carriers shown on this certificate have an A.M. Best Rating A XV unless otherwise noted.
ocation: 1016 - Ft. Collins, CO Type of Company: City Municipality Job Description: Clerical and administrative
upport
11.,MM 1 IrII..A I r- MULUtFS L:ANUtLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
City of Fort Collins WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
Attn: James O'Neill CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
215 North Mason Street SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Fort Collins CO 80521 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)
rel
TION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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