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HomeMy WebLinkAboutADECCA INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 229 D„ 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 endomement(s). PRODUCER AOn Risk Insurance Services West, Inc. San Francisco CA Office CONTACT NAME. IN (84]) 953-5390 INC. No. Eat); (866) 283-7122 Me No.): E-MAIL ADDRESS: 199 Fremont Street suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC # 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 [KH73;TaIH3�tl4A0;1[Nil1:12PL'd-74c tt••:a V AN1.1[a]a,2UId1.1=1 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 WVD POLICY NUMBER POLICY EFF an MIDDIYYrrQ I POLICY Elo' MMIDo LIMITS e GENERAL LIABILITY OL EACH OCCURRENCE $2,000,000 % COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence$2,000,000) CLAIMS -MADE X❑OCCUR MED EXP(Any one onion) EXCluded PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $4,000,006 X POLICY PRO- CT LOC e e AUTOMOBILE LIABILITY CA 4309751 CA 4309752 01/01/2012 01/01/2012 01O1 2013 01/01/2013 COMBINED SINGLE LIMIT Ea accrientl $2,000,000 BODILY INJURY( Per Person) AINY AUTO MA ALL OWNED SCHEDULED BODILY INJURY (Per aaadent) AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Par ecchdar C X UMBRELLA LAB OCCUR U500045047L112A 01/01/2012 01/01/2013 EACH OCCURRENCE $5,000,000 EXCESS LAB N ClAIM11S&MDE SIR applies per policy terns & condi ions AGGREGATE $5,000,000 DED I % RETENTION S10, 000 F F WORKERS COMPENSATION AND EMPLOYERS' LAILRY EYIN ANY PROPRIETORIPARTNERIE%ECUTIVE OFFICENMEMBER E%CLODEDi NIA WC019736716 CA wc019736717 01/01/2012 01/01/2012 O1/01 2013 01/01/2013 X WC STATU- OTH- TORV LIMITS R El. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,006 (Mandatory In NM FL It yes, desrdbe under WeOF OPERATIONS Calow - 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) Branch Location: AdeCCO Engineering & Technical, 300 E. Boardwalk, Fart 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 VVTH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed BOnnette 21SFor N. Mason St. Sn �y � �' y� uild �'X= Fort Collins Co 80522 USA eriNo/ a(/7yJ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD