No preview available
HomeMy WebLinkAbout131163 ADECCO TECHNICAL - INSURANCE CERTIFICATE (5)�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 12/30/2010 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER ,non Risk insurance Services west, Inc. San Francisco CA Office CONTACT - NAME. (A/cC. No. Ext): (415) 486-7000 FAX No.): (415) 486-7029 E-MAIL ADDRE S: 199 Fremont. Street., Suite 1500 San Francisco CA 94105 USA PRODUCER CUSTOMER ID#:570000018187 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ills CO of Pittsburgh 19445 Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA INSURERB: New Hampshire Ins Co 23841 INSURER C: Insurance Company of the State of PA 19429 INSURERD: Chartis Casualty Company 40258 INSURERE: Illinois National Insurance Co 23817 INSURER F. COVERAGES CERTIFICATE NUMBER: b/UU412Ut3tiUti REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requests INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY GL44 EACH OCCURRENCE $2 , 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES Ea occurrence $2 , 000, 000 CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) EXCi uded PERSONAL &ADV INJURY $2,000,000 ' GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4 , 000, 000 X POLICY PRO LOC A ,A AUTOMOBILE X LIABILITY ANY AUTO CA 4309347 CA 4309348 MA 01/01/2011 01/01/2011 01/01/2012 01/01/2012 COMBINED SINGLE LIMIT Ea accident)$2 , 000 , 000 BODILY INJURY ( Per person) ALL OWNED AUTOS - BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS Per accident X NON OWNED AUTOS UMBRELLA LIAR EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DEDUCTIBLE RETENTION C _ C WORKERS COMPENSATION AND _EMPLOYERS' LIABILITY _ _ Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) NIA wc061967109 CA WC061967110 FL 01/01/2011 01/01/2011 01/01/2012 01/01/2012 WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT' $2 , 000,000 E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2 , 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location: AdeCCO Engineering & Technical, 4025 Automation way F1, Fort Collins, CO 80525. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette 215 N. Mason St. (� Fort Collins Co 80522 USA N v m` w c m a `m 0 2 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/3012010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Aon Risk Insurance Services West, Inc. San Francisco CA Office CONTACT NAME. (aIc°.Nri . Ez[): (415) 486-7000 (AIC No : (415) 486-7029 E-MNL ADORES : 199 Fremont. Street Suite 1500 San Francisco CA 94105 USA PRODUCER 570000018187 CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 Adecco Inc. 175 Broad HolloW Road Melville NY 11747-4902 USA INSURER B: NeW Hampshire Ins CO 23841 INSURER C: Insurance Company of the State of PA 19429 INSURER D: Chdrtis Casualty Company 40258 INSURERS: Continental Casualty Company 120443 INSURERF: ACE American Insurance Company 122667 COVERAGES CERTIFICATE NUMBER: 570U412U7598 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requests INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A GENERAL LIABILITY GL EACH OCCURRENCE $2 , 000 , 000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES Ea occurrence $2 , 000, 000 CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) EXCI uded PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG X POLICY PRO LOC JECT A AUTOMOBILE LIABILITY CA 4309347 Ol Ol 2011 01/01/2012 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY ( Per person) X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS - PROPERTY DAMAGE X HIRED AUTOS Per accident X NON OWNED AUTOS A X UMBRELLA LIAR OCCUR 15972685 01/01/2011 0110112012 EACH OCCURRENCE $5,000,000 EXCESS LIAR H CLAIMS -MADE SIR applies per policy terns & conditions AGGREGATE $5,000,000 DEDUCTIBLE X RETENTION $ 2 5 , 000 C C _ WORKERS COMPENSATION AND :ER 'cMPLOYERS' LIABILITY. YIN ANYIPROPRIE FOR/ PARTNER / EXECUTIVE' OFFICER/MEMBEREXCLUDED? (Mandatory in NH) _ .. N/A ,. wc061967109 CA WC061967110 FL 01/01/2011 Ol/Ol/2011 01/01/2012 01/Ol/2012 Wc ORY ST ITS oTH- X I E.L. EACH ACCIDENT $2 , OOO {OOO E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2 , 000, 000 E E&O-ProfLiabPri 167112912 01/01/2011 01/01/2012 Each wrongful Act $1,000,000 SIR applies per policy terns & conditions General Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location: AdeCCO Technical 4025 Automation way Suite F1 Fort Collins, Co 80525 CERTIFICATE HOLDER City of Fort Collins Attn: Ed Bonnette 215 N. Mason St. Fort Collins Co 80522 USA CANCELLATION W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ;,Q2 e946n �J�tdr�ianes, ylu, 0 i G f= ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �- CERTIFICATE OF LIABILITY INSURANCE DATE20MM/20D'/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER AOn Risk Insurance Services west, Inc. San Francisco CA office CONTACT _ NAME: (A/C.NNo. Ext): (415) 486-7000 - A/C. No.): (415) 486-7029 - - E-MAIL - - - - ADDRESS• 199 Fremont Street Suite 1500 San Francisco CA 94105 USA PRODUCER CUSTOMER ID#:570000018187 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 Adecco USA, Inc. 175 Broad Hollow Road Melville NY 11747-4902 USA INSURER B: New Hampshire Ins Co 23841 INSURERC: Insurance Company of the State of PA 19429 INSURERD: Chartis Casualty Company 40258 INSURERE: Illinois National Insurance CO 123817 INSURER F: COVERAGES CERTIFICATE NUMBER: 570041201766 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requests LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A GENERAL LIABILITY GL 7777n7EACH OCCURRENCE $2 , 000 , 000 X COMMERCIAL GENERAL LIABILITY AMA PREMISES Ea occurrence $2 , 000 , 000 CLAIMS-MADE X❑ OCCUR MED EXP (Any one person) Excluded " PERSONAL & ADV INJURY $2 , 000, 000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4 , 000 , 000 X I POLICY PRO LOC JECT Empl Benefit Liab $2 , 000, 000 A A AUTOMOBILE X LIABILITY ANY AUTO CA 4309347 ADS CA 4309348 01 01 201101/01/2012 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY (Per person) ALL OWNED AUTOS MA BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS ' Per accident X NON OWNED AUTOS '4 X UMBRELLA LIAB OCCUR 15972685 01 01 2011 01/01/2012 EACH OCCURRENCE $ 5 , 000, 000 EXCESS LAB R CLAIMS -MADE SIR applies per policy ter s,& conditions AGGREGATE $5,000,000 DEDUCTIBLE X RETENTION $25,000 C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A wC061967109 CA WC061967110 FL 01 01/2011 01/01/2011 01/01/2012 01/01/2012 WC sTATu- OTH-. X TGRY LIMITS I JER E.L. EACH ACCIDENT $2 , 000 , 000 E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below - E.L. DISEASE -POLICY LIMIT $2 , 000 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins, Co 80525. d w c m d 32 0 y CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE A215 ttn: Ed. Bonnette DVS• S/�T S/�T N. Mason St. For t on ` �:�O�C✓�tdfLta �Gfit�CYO /% ✓9Ju Fort Collins CO 80522 USA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD