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HomeMy WebLinkAboutCORRESPONDENCE - RFP - P1081 TEMPORARY PERSONNEL SERVICES (11)Holder Identifier : 300 7777777707070700077761616045571110767717016204447207442027772507300072640577046230130777051513567000307573150673675503071372730235333210763151027006621207724055530076570076727242035772000777777707000707007 7777777707070700073525677115456000732001407027113107122326353173001070223362430621110702323624207311007033336342062010070223373521720010702232734217311007133336252063101077756163351765540777777707000707007 Certificate No : 570043720830 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/09/2011 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). 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. PRODUCER Aon Risk Insurance Services West, Inc. San Francisco CA Office 199 Fremont Street Suite 1500 San Francisco CA 94105 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURER B: New Hampshire Ins Co 23841 INSURER C: Insurance Company of the State of PA 19429 INSURER D: Chartis Casualty Company 40258 INSURER E: Illinois National Insurance Co 23817 INSURER F: FAX (A/C. No.): (847) 953-5390 CONTACT NAME: COVERAGES CERTIFICATE NUMBER: 570043720830 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 POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL TYPE OF INSURANCE INSR POLICY NUMBER LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE 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. INSURER INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. 175 Broad Hollow Road Melville NY 11747 USA Adecco Inc. INSURED Attachment to ACORD Certificate for Adecco Inc. TYPE OF INSURANCE POLICY NUMBER/ POLICY DESCRIPTION LIMITS WORKERS COMPENSATION D WC061967106 01/01/2011 01/01/2012 B WC061967107 01/01/2011 01/01/2012 C WC061967113 01/01/2011 01/01/2012 C WC061967111 01/01/2011 01/01/2012 B WC061967108 01/01/2011 01/01/2012 B WC061967112 01/01/2011 01/01/2012 E WC061967122 01/01/2011 01/01/2012 AOS AL,CO,DE,ME,MI,MT,NJ,NV,SC,VT ND,WA,WI,WY OR MA,NY TX MN N/A N/A N/A N/A N/A N/A N/A ADDL INSR INSR LTR SUBR WVD POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) SIR applies per policy terms & conditions Certificate No : 570043720830 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $2,000,000 Excluded $2,000,000 $4,000,000 $4,000,000 A GL4406192 01/01/2011 01/01/2012 PRO- JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X X X BODILY INJURY (Per accident) $2,000,000 A 01/01/2011 01/01/2012 A CA 4309348 01/01/2011 01/01/2012 MA COMBINED SINGLE LIMIT (Ea accident) CA 4309347 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 $25,000 01/01/2011 SIR applies per policy terms & conditions A UMBRELLA LIAB 15972685 01/01/2012 X RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $2,000,000 X OTH- ER WC STATU- TORY LIMITS C 01/01/2011 01/01/2012 CA C WC061967110 01/01/2011 01/01/2012 $2,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A FL WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $2,000,000 WC061967109 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 CityREPRESENTATIVE of Fort Collins AUTHORIZED Attn: Ed Bonnette 215 N. Mason St. Fort Collins CO 80522 USA ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.