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Home My WebLink About130882 LABOR READY - INSURANCE CERTIFICATE (2)ACORD. CERTIFICATE OF LIABILITY INSURANCE 7/1/zolz DATE 4/17/2012yv) 2012 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 Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 CONTA NAM CT PR A/c No at): INC,FAX No E-MAIL ADDRESS' INSURER AFFORDING COVERAGE C (303) 414-6000 p INSURERA: National Union Fire Ins CO Pittsburgh PA 19445 U D INSURED Labor Ready 1332617 (SeeAttached Named Insured Schedule) INSURER B; New Hampshire Insurance Company 23841 INSURER C: Insurance Company of the State of PA 19429 INSURER D: PO Box 2910 INSURER E: Tacoma, WA 98401 1354-1150 IN RERF: COVERAGES TRUBL02 LS CERTIFICATE NUMBER: 11736735 REVISION NUMBER: XXXXXXX 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. LTRR TYPE OF INSURANCE ADDL INSR WVD SUER POLICY NUMBER MMIDOY EFF MMI�UY/YYVPY LIMITS A GENERAL LIABILITY Y N 2449531 7/l/2011 7/1/2012 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X�OCCUR DAMAGE EaBOcccurrence 1000000 MED EXP (Any oneperson) XXXXXXX PERSONAL 8 ADV INJURY $ 1,000,000 X Host Liquor $ I M X SIR$IM GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG0X P LILY JRO L C A AANYppAUTO AUTOMOBILE LIABILITY Y N 3506385-AOS 3506386-VA 7/1/2011 7/1/2011 7/1/2012 7/12012 OMLa BB.INEDtSINGLELIMIT BODILY INJURY(Per person)XXAUTOS�ED N0000X000 p AUTOOSULED BODILY INJURY(Per accrdenlXXHIRED AUTOSNON-OWNED TOS PerOPERTY DAMAGE XXXXUMBRELLA LIAR OCCUR EACH OCCURRENCE XX EXCESS LIAB CLAIMS -MADE NOT APPLICABLE AGGREGATE s XXXXXXX DEO I I RETENTION $ $ B B C WORKERS COMPENSATION AND EMPLOYERS'AYIN ANYIPROPRIETORVPARTNERECUTIVE ❑N (Mend.., in NH, If yes deseode ume, DESCRIPTION OF OPERATIONS Cebx NIA N 015883787-AOS & 015883778- 015883781-FL&015883791-M 0 1 5883788-MA & 0 15883783-0 1/1/2011 7/1/201 7/1/2011 /1012 7//20 2 7/l/2012 OTH X iaTS EL. EACH ACCIDENT $ 1,000,000OFFCE"EMBEREXCLUDEDt E.L. DISEASE - EA EMPLOYEE 1,000000 EL DISEASE -POLCY LIMIT A 1,000,000 A Excess Work Comp N N 1192421-QSI 7/12011 7/1/2012 WC- Sierutory; EL Liteit$1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) The above coverages apply only to Temporary Labor Ready employees dispatched to do work on behalf of the Certificate Holder. The City of Fon Collins, its officers, aPents and employees are named as Additional Insured per written contract between Labor Ready and the City of Fort Collins as respects General and %auto Liability. 11736735 City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Th. arnwn .aeon seei lnnn are rnninfnrnH e.ar4a of arnran TInM All dnMc mner..ew SCHEDULE OF NAMED INSUREDS Labor Ready Affiliates' States of Operation Please refer to the chart below to find the Labor Ready entity Named Insured for the state in which temporary workers are dispatched to work. Labor Ready Entity Labor Ready Northeast, Inc. Labor Ready Southeast, Inc. Labor Ready Mid -Atlantic, Inc. Labor Ready Central, Inc. Labor Ready Midwest, Inc. Labor Ready Northwest, Inc. Labor Ready Southwest, Inc. Labor Ready, Inc. Labor Ready Holdings, Inc. Spartan Staffing, LLC Spartan Staffing Puerto Rico, LLC PTPR, Inc. Job Rooster, Inc. Centerline Drivers, LLC Venue Ready, LLC PlaneTechs, LLC Drivers on Demand, LLC TrueBlue Enterprises, Inc. TrueBlue Inc. PAC States of Operation Connecticut, Maine, New Jersey, Delaware, Maryland, New York, District of Columbia, Massachusetts, Pennsylvania, Rhode Island, New Hampshire, Vermont Alabama, Kentucky, Louisiana, Georgia, Mississippi, Florida Indiana, Ohio, Virginia, North Carolina, South Carolina, West Virginia, Tennessee Arkansas, Missouri, Texas, Colorado New Mexico, Wyoming, Kansas, Oklahoma Illinois, Minnesota, South Dakota, Iowa, Nebraska, Wisconsin, Michigan, North Dakota Alaska, Montana, Oregon, Hawaii, Washington, Idaho Arizona, Utah, California, Nevada Miscellaneous Attachment: M 19451 Master ID: 1332617, Certificate ID: 11736735 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M. 07/01/11 forms a part of Policy No. 2449531 Labor Ready Northeast, Inc.; Labor Ready Southeast, Inc.; Labor Ready Mid -Atlantic, Inc.; Labor Ready Central, Inc.; Labor Ready Midwest, Inc.; Labor Ready Northwest, Inc.; Labor Ready Southwest, Inc.; Spartan Staffing, LLC; Venue Ready, LLC; PlaneTechs, LLC; TransTechs; & Centerline Drivers, LLC and GL 2449532 CLP Resources, Inc. & Project Trade Solutions, LLC Issued to Spartan Staffing, LLC; CLP Resources, Inc.; Centerline Drivers, LLC; PlaneTechs, LLC; Project Trade Solutions, LLC; & Venue Ready, LLC By National Union Fire Insurance Company ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED, is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability caused in whole or in part: A. by your acts or omission in the performance of your ongoing operations; or B. in connection with your premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: • The coverage and/or limits of this policy, or • The coverage and/or limits required by said contract or agreement. Miscellaneous Attachment: M56029 Certificate ID : 11736735 ENDORSEMENT This endorsement, effective 12:01 A.M. 7/1/2011 forms a part of Policy No. CA 3506385 & 3506386 issued to Labor Ready Northeast, Inc.; Labor Ready Southeast, Inc.; Labor Ready Mid -Atlantic, Inc.; Labor Ready Central, Inc.; Labor Ready Midwest, Inc.; Labor Ready Northwest, Inc.; Labor Ready Southwest, Inc.; Spartan Staffing, LLC; CLIP Resources, Inc.; Centerline Drivers, LLC; PlaneTechs, LLC; Project Trade Solutions, LLC & Venue Ready, LLC by National Union Fire Insurance Company of Pittsburgh, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modified insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: "Any person or organization for whom you are contractually bound to provide Additional Insured status but only to the extent of such person or organizations liability arising out of the use of a covered "auto". I. SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement 87950 (10/05) Miscellaneous Attachment: M 103493 Certificate ID : 11736735