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HomeMy WebLinkAbout131163 ADECCO USA INC - INSURANCE CERTIFICATEA O® CERTIFICATE OF LIABILITY INSURANCE DATE2rz9122011Ym 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(iss) 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 endomement(s). PRODUCER AOn Risk insurance Services west, Inc. San Francisco CA office CONTACT NAME. AX INC �Ne. Ban: (415) 486-7000 FNG No.):(415) 48fi-7W9 E-MAIL ADDRESS: 199 Fremont Street Suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC a INSURED INSURER A: New Hampshire Ins CO 23841 Adecco USA, Inc. 175 Broad Hollow Road INSURER B: National union Fire I0s CO of Pittsburgh 19445 INSURER C: XL insurance America Inc 24554 Melville NY 11747-4902 USA INSURERD: Chartis Casualty Company 40258 INSURER E: Illinois National Insurance Co 23817 INSURER F: Insurance Company Of the State Of PA 19429 COVERAGES CERTIFICATE NUMBER: 570044867147 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 INSR LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER MINDD MMIDD LIMITS B GENERAL LIABILITY GL EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY w PREMISES Ea occurrence) $2,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) Excluded PERSONAL B ADV INJURY S2,000,000 GENERAL AGGREGATE $4,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S4,000,000 X POLICY PRFJECT-] Empl Benefit Lia6 $2,000,000 B AUTOMOBILE LIABILITY CA 4309751 ADS 01 Ol 2012 01 01 2013 COMBINED SINGLE LIMIT $2,000,000 BODILY INJURY (Per person) B X ANY AUTO CA 4309752 01/01/201201/01/2013 BODILY INJURY (Per accident) ALL OWNED SCHEDULED MA AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Peraccidenl D % UMBRELLA this % OCCUR US00045047L112A 01/01/2012 01/01/2013 EACH OCCURRENCE $5,000,000 EXCESS LIAR CI-AIMS-MADESIR applies per policy ter is & condi ions AGGREGATE $5,000,000 DED I % RETENTION 110, 000 F F WORKERS EMPLOYERS MAPBEINSTAyTION AND YIN ANTPROPRIETOR I PARTNER (EXECUTIVE OFFICEWMEMBER EXCLUDED? (Mundane, In NM NIA CA019736716 wC019736717 FL 01 01 2012 Ol/Ol/2012 01/01/2013 Ol/Ol/2013 X woaY L1MSTBU ER E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 I nc tieacdbe under DESCRIPTION OF OPERATIONS below 1 E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 101, Additional RemaMe 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 N. Mason St. For Fort Mason CO 80522 USA (✓/� %�j�// 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD � -a "✓R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YWY) 1 12/29/2011 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: PHONE (g66) 283-]122 FAX (847) 953-5390 INC. NP. E:q: INC. No.: E# L ADDRESS: 199 Fremont Street Suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC e 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 INSURERD: Chartis Casualty Company 40258 INSURER E: Illinois National Insurance Co 23817 INSURER F: Insurance Company of the State of PA 19429 COVERAGES CERTIFICATE NUMBER: 570044897746 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 INSR LTR TYPE OFINSURANCE ADDi INSR IWO POLICY NUMBER MkUDD MMIDIVYYYY1 LIMBS B GENERAL LIABILITY GL2705074 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwPon.)$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'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $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 a cmdenl $2, 000, 000 BODILY INJURY ( Per Person) AINY AUTO MA ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NONINED AUTOS BODILY INJURY (Per edoldent) PROPERTY DAMAGE Per accident D X UMBRELLA UAB X OCCUR U500045047L112A 01/01/2012 01/01/2013 EACH OCCURRENCE S5,000,000 EXCESS LLTB CI -AIMS -MADE SIR applies per policy terns & condi ions AGGREGATE $5,000,000 DED I X RETENTION 310, 000 F F WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR I PARTNER I EXECUTIVE OFFICEWMEMBER EXCLUDE09 N/A wc019736716 CA WC019736717 01/01/2012 O1/O1/2012 01/01/2013 O1/O1/2013 WC sTATU- OTH- X TORY LIMITS EL. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 (Wndelory In NM Ues,desmoo under 50 IPTION OF OPERATIONS below FL E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANsch 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 WRH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette N. Mason Fort Collins For St. CO 80522 USA ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD