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HomeMy WebLinkAbout131163 ADECCO TECHNICAL - INSURANCE CERTIFICATE (3)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/12/2010 PRODUCER Aon Risk insurance Services West, Inc. San Francisco CA Office THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 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 tt PHONE.. 415 486-7000 FAX 415 486-7029 INSURED INSURER National Union Fire ins Co of Pittsburgh 19445 Adecco USA, Inc. 175 Broad Hollow Road INSURERB: Insurance Company of the state of PA 19429 INSURER(: New Hampshire Ins Co 23841 Melville NY 11747-4902 USA INSURERD: Chartis Casualty Company 40258 INSURER E: O COVVRACFS SIR aoDlies Der terms and conditions of the Dolicv x 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 I%IAY 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 ADD LTR INSRII TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE MM/DD/ DATE(MM/DD/YYYY) A ENERAL LIABILITY GL7146115 01/01/2010 01/01/2011 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 0,000,000 PREMISES (Ea occurrence) MED EXP Anv one person) CLAIMS MADE © OCCUR PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- 3 POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $4 , 000 , 000 Empl Benefit Liab $2,000,000 IECT A AUTOMOBILE LIABILITY CA 6647480 01/01/2010 01/01/2011 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 AUTO ONLY: AGG A EXCESS/UMBRELLA LIABILITY 27471643 01/01/2010 0110112011 EACH OCCURRENCE ElOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 HDEDUCTIBLE RETENTION $25,000 8 e 8 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y(.y IN I ANY PROPRIETOR/PARTNER/EXECUTIVE LL_JI OFFICER/MEMBER EXCLUDED? (Mandatory in NH) wC CA wCO20342163 FL wc02O342164 01/01/2010 01/01/2010 01/01/2011 01/01/2011 X C STATU- OTH- E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 Ifres. describe wder SPECIAL PROVISIONS belo,- OR OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins, CO 80525. r,n I Ir Ia_ % I c n"Lur.tt l A1NUELLA I IVIN 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. .10 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 REPRESENTATIVE �Iy J.;111 ACORD 25 (2009/01) C1988-2009 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD u-i O n 00 a) rn m O O Attachment to ACORD Certificate for Adecco USA, 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 USA, Inc. 175 Broad Hollow Road Melville NY 11747-4902 USA 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 POLICY DESCRIPTION EFFECTIVE EXPIRATION LIMITS DATE DATE WORKERS COMPENSATION wc02O342159 1/01/2010 01/01/2011 D All Other States wc02O342166 1/01/2010 01/01/2011 B ND,WA,WI,WY wc02O342160 1/01/2010 01/01/2011 C AL,CO,DE,MA,ME,MI,MT,Nl,1 wc02O342161 3110112010 01/01/2011 C Work Comp: MN,NY wc02O342165 0110112010 01/01/2011 C Workers Camp -Tx DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570039831705