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HomeMy WebLinkAboutADECCO USA INC - INSURANCE CERTIFICATE��- CERTIFICATE OF LIABILITY INSURANCE DATE08/12 2010 os/1z/zolo 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 San Francisco CA 94105""USA "' PHONE- 415 1 486-7000:,. _. FAxi- 415 486-7029 COVERAGE AFFORDED BY THE POLICIES BELOW. " INSURERS AFFORDING COVERAGE - -" -- "' - o '-NAIC #, INSURED i 'Adecco�USA, Inc. i i175 Broad'Ho1`low"Road INSURER A: National uni On;Fire•11ls - Co of Pittsburgh 19445 ; •' 19429 ±e= INSURERB: Insurance Company,of.•-the State of:PA INSURER C. New Hampshire Ins_ co. _ _ .,..._..._... .._ 23841 d Mel vj 11 e, NY;:11747-4902 USA INSURERD: Chartis casualty';Cornpany . -:.; 40258 � O .... INSURER E: C0VF.RAf:F.3 SIR applies Der terms ano COnaitions oT the Dollcv 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 ADD' LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS, ATE MM/DD DATE MM/DDI A GENERALLIABILITY GL714611S 01/01/2010 01/01/2011 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S2,000,000 CLAIMS MADE ® OCCUR - PREMISES (Ea occurrence) M (Am one person) EXC u e PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4, 000, 000 GENT, AGGREGATE LIMIT APPLIES PER: ❑X POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $4 , 000, 0OO Empl Benefit Liab $2,000,000 JECT A AUTOMOBILE LIABILITY CA 6647480 . 01/01/2010 0110112011- - - COMBINED SINGLE LIMIT - - X ANY AUTO L._.._........... ..... _.._-_,...,. ._ ..... (Ea_acudrn0,_....-._. u -.ALL OWNED.AUTOS.'�j _ „ .,, ,. _ - BODILY.. INJURY-_.- SCHEDULED AUTOS: ,. .-... - I .'�., r _ .. (Perperson)•, ' - X HIRED AUTOS .. -. . . •, -. ..... .. ,BODILY INJURY'' ..'. X", ' NON.OWNED;AUTOS"-'.., __ .. .. '(Peraccidrnl) PROPERTY DAMAGE -..._-_- . -. ... ..... ..... - . ... _. ... (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY AGO A EXCESS / UMBRELLA LIABILITY 27471643 01/01/2010 0110112011 EACH OCCURRENCE ElOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 - ®DEDUCTIBLE RETENTION $25,000 B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/ PARTNER / EXECUTIVE MandaOFFICEtoryinN0ER IXCLUDED'? WC wCO20342163 FL wc02O342164 01/01/2010 01/01/2010 Ol/Ol/Z011 01/01/2011 X C STATU- ORY LIMITS OTH- E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2 , 000, OOO If es, describe order SPECIAL PROVISIONS below OR OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins, Co 80525. - LEHIIrILAIE HULOEK CAACELLA 10N • City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn: Ed. Bonnette DATE THEREOF, THE IS INSURER WILL ENDEAVOR TO MAIL 215 N . Mason St. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Fort Collins Co HO52 2 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVES ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD O r\ 14 00 m M O O r, Attachment to ACORD Certificate for AdeCCD 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. LTR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY DESCRIPTION POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS WORKERS COMPENSATION wc02O342159 All other States 1/01/2010 01/01/2011 li wc02O342166 ND,WA,WI,WY 1/01/2010 01/01/2011 C wc02O342160 AL,CO,DE,MA,ME,MI,MT,NJ,I 1/01/2010 01/01/2011 C wc02O342161 work Comp: MN,NY 1/01/2010 01/01/2011 C wc02O342165 Workers Comp -Tx 0110112010 01/01/2011 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate No : 570039831705