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HomeMy WebLinkAbout131163 ADECCO TECHNICAL - INSURANCE CERTIFICATE (6)s " o CERTIFICATE OF LIABILITY INSURANCE DATE(M1WDDNYYY) o9109t2o1$ 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`6ETWEEWTHE 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. lf.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 Ileu of such endorsement(s). ' PRODUCER AOntR15k insurance "Services West, Inc.' San _Fran Ci SCO CA Offi Ce" CONTACT - NAME: - PHONE- (866) 283-7122 ": ^'F .'. FAX" " (84]) 953-5390 „ INC. No. Eat):INC. No.: 199 Fremont Street. Suite 1500 E-MAL ADDRESS: San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NNCa INSURED INSURER A: National Union Fire Ins CO of Pittsburgh 19445 Adecco Inc. 175 Broad Hollow Road INSURER B: New Hampshire Ins CO 23841 INSufteRC: Insurance Company of the State Of PA 19429 Melville NY 11747 USA INSURER D: Charti5 Casualty Company 40258 INSURER E: Illinois National Insurance CO 23817 INSURER F: GUVEKA(i CEKIIhIOAIE NUMBER: b7UU4J/2UdJU 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 requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDOrrYVY, (MwDD1YYYyI1 LIMITS GENERAL LIABILITY GL EACH OCCURRENCE $2,000,005 X COMMERGAL GENERAL 11ABILITY - _ - - PREMISES Ea orartence $2,000,000 CLAIMS -MADE OCCUR MED EXP(Any one person):. = E%Cluded PERSONAL& ADV INJURY $2,000,000 � , , GENERAL AGGREGATE $4, 000, 000 � ",I. .:,>"^'•":�.,. � '• , .4.SI i,,., �. GATE LIMIT APPLIES GEN'L AGGREGATE I S PER: �. PRODUCTS - COMP/OP AGO i'I• "E4, 000; 000 X POLICY. a.. Pft6,_ ._ LOC '. :: ... _ ... .. ,A . AUTOMOBILE LIABILITY. -... .. .- -., CA'430934 .. 010120110101 Ol COMBINED SINGLE UMr $2,000,000 A .. CA 4309348 ; `.: .' ; 01/01/2011 01/01/2012 4E..0 Jam .. XIANYAUTO MA BODILY INJURY I Per person) ALL OWNED SCHEDULED BODILY INJURY(Peraccident) - AUTOS AUTOS I PROPERTY DAMAGE X HIRED AUTOS % NON -OWNED AUTOS Per accident A X UMBRELLA LIAB X OCCUR 15972685 01/01/2011 01/01/2012 EACH OCCURRENCE $5,000,000 SIR applies per policy ter is & COndl IODS AGGREGATE $5,000,000 EXCESS LIA9 CLAIMS -MADE DED I X RETENTION $25,000 C WORKERS COMPENSATION AND WC061967109 01 O1 2011 01/01/2012 WC STATU- OTM- X TORY LIMITS R EMPLOVERS' LIABILITY YIN CA E.L. EACH ACCIDENT $2,000,000 C ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERrMEMeEP EXCLUDED? NIA wc061967110 01/01/2011 01/01/2012 E.L. DISEASE -EA EMPLOYEE $2, GDG, DDD (MyanEa[ory In NH FL It a, di,tcrbe under E.L. DISEASE -POLICY LIMIT $2, 050,000 DESCRIPTON OF OPERATIONS below I I Tl DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Branch Location: AdeCCO Engineering & Technical, 300 E. Boardwalk, 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 Mason On St. For FortCollinsn CO 80$22 USA ✓(/ JLi/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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, coverages or exclusions contained in the policy. INSURED Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA ADDITIONAL POLICIES If a policy below does no INSURER IIN4113:13 include limit information. refer to the correspondine DOlicv on the certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSR SURR W VD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DD/YYYY) POLICY EXP (M\UDD/YYYY) LLMITS WORKERS COMPENSATION D N/A WC061967106 AOS 1 O1 2 111 01 01 2012 B N/A WC061967107 AL,CO3DE,ME,MI,MT,N3.NV,: 1/01/201 01/01/2012 C N/A wc061967113 ND,WA,WI, WY 0110112011 01/01/2012 C N/A WC061967111 OR 1 O1 2011 01/01/2012 B N/A WC061967108 MA, NY 1/01/2013 01/01/2012 B N/A WC061967112 TX SIR applies per policy to 0110112011 ms & condit 01/01/2012 ons E N/A WC061967122 MN 1/01/201 01/01/2012 Certificate No : S70043720830