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HomeMy WebLinkAbout131163 ADECCO TECHNICAL - INSURANCE CERTIFICATE (4)A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/02/2010 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 -- INSURERB: Insurance Company of the state of PA 19429 Adecco Inc. I=" 175 Broad Hollow Road INSURERC: New Hampshire Ins Co 23841 Melvil-le NY 11747"USA d INSURERD: Chartis casualty Company 40258 �., _ . .. ^Q INSURER E: O. x Ad-Ve SIR annl i es ner terms and conditions of the policy 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' INS TYPE OF INSURANCE - POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY POLICY EXPIRATION DATE(MM/DD/YYYY) LIMITS A ENERAL LIABILITY GL7146115 01/01/2010 01/01/2011 EACH OCCURRENCE $2 , 000 , 000 DAMAGE TO RENTED $ 2 , 000 , 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [E] OCCUR PREMISES (Ea occurrence) MED EXP (Any one person) 1QQ , QQQ PERSONAL & ADV INJURY $ 2 , 000 , 000 ElGENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 E POLICY ❑ PRO- ❑ LOC JECT A AUTOMOBILE LIABILITY CA 6647480 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) - $ 2 , 000 , 000 BODILY INJURY - ALL OWNED AUTOS SCHEDULED AUTOS ( Per person) BODILY INJURY X HIRED AUTOS _ )( NON OWNED AUTOS - (Per accident) PROPERTY DAMAGE - (Per accident) GARAGE LIABILITY - AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO HANY AUTO ONLY : AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE HDEDUCTIBLE RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N� wc02O342162 CA wc02O342163 0110112010 01/01/2010 01/01/2011 X wC STATU- TOR, LIMITS 0 ER E.L. EACH ACCIDENT $2,000,000 p ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below FL wc02O342159 AOS 01/01/2010 01/01/2011 E.L. DISEASE -EA EMPLOYEE $ 2 , 000 , 000 E.L. DISEASE -POLICY LIMIT t $ 2 , 000 , 000 OTHER 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 City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn : Ed Bonnette 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, Fort Collins Co 80522 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVEyyafia��s�itac.ir.Gs„ad� ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD lfl O 00 m n rn O Ln •1! 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, covera¢es or exclusions contained in the Dolicv. INSURED Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA ADDITIONAL POLICIES INSURER - - - INSURER INSURER INSURER INSURER 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 POLICY DESCRIPTION EFFECTIVE EXPIRATION LIMITS DATE DATE WORKERS COMPENSATION - - C wc02O342160 0110112010 01/01/2011 AL,CO,DE,MA,ME,MI,MT,NJ,I wc02O342166-- 1/01/2010 01/01/2011 B ND,WA,WI,WY wc02O342164 1/01/2010 01/01/2011 B OR wc02O342161 0110112010 01/01/2011 C MN,NY WCO20342165 0110112010 01/01/2011 C TX DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS f Certificate No : 570037383906