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HomeMy WebLinkAbout131163 ADECCO INC - INSURANCE CERTIFICATE1 ® " o CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 2126I2011 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' AcNNe. Est): (B66) 283-7122 aC (847) B53-5390 199 Fremont Street Suite 1500 E-MAIL ADDRESS: San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAICs INSURED INSURER A: New Hampshire Ins Co 23841 Adecco Inc. 175 Broad H011OW Road INSURER B: National union Fire Ins Co of Pittsburgh 19445 INSURER C: XL Insurance America Inc 24554 Melville NY 11747 USA INSURER D: Chartis Casualty Company 40258 INSURER E: Illinois National Insurance Co 23817 INSURER F: Insurance Company of the State Of PA 19429 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 MD POLICY NUMBER MMIDD te"I'DIDITTInrl LIMBS B GENERAL LIABILITY GL EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocmnance $2,000,000 CLAIM&MADE X❑OCCUR MED EXP(Any one person) EXcluded PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $4,000,000 X POLICY PRO- LOG B B AUTOMOBILE LIABILITY CA 4309751 CA 4309752 01/01/2012 01/01/2012 01/01/2013 01/01/2013 COMBINED SINGLE LIMIT Ea accident)S2,000,000 BODILY INJURY I Per parson) X ANY AUTO MA ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Pera¢ident C UMBRELLA LIM X OCCUR US00045047L112A 01/01/2012 01/01/2013 EACH OCCURRENCE $5,000,000 IDED EXCESS LIAR CLAIMS -MADE SIR applies per policy terns & condi ions AGGREGATE $5,000,000 X RETENTION 310, 000 F F WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN My PROPRIETOR I PARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED) NIA wcO19736716 CA wC019736)17 01/01/2012 Ol/Ol/2012 01/01/2013 Ol/Ol/2013 X WC STATU- TORV LIMITS OTH- R E.L. EACH ACCIDENT $2,000,006 E.L. DISEASE -EA EMPLOYEE $2,000,000 (Mandate, In NH) FL If desmoeunder ES DCRIPTION OF OPERATIONS tlelow E.L. DISEASE -POLICY LIMIT $2,000,000. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It mom apace N 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 AUTHORDED REPRESENTATIVE A215 ttn: Ed Bonnette N. Mason St. For Fort Collins CO 80522 USA tCXXI/OO ✓LAbi✓ V 4D1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD