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HomeMy WebLinkAbout131163 ADECCO USA INC - INSURANCE CERTIFICATE (2)ACORO ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDM YY) 1 vDvzolz 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 (415) 486-7000 FAX (415) 486-7029 INC. No. Ertl: AIC. No.: E-MAIL ADDRESS: 199 Fremont.Street Suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC s INSURED INSURER A: National Union Fire Ins CO of Pittsburgh 19445 Ad---- USA, IOG '�/) \�\\ 175 Broad H011OW Road Melville NY 11747-4902 USA INSURER an New Hampshire Ins CO 23841 INSURER C: Insurance Company Of the state Of PA 19429 INSURER D: Illinois National Insurance CO 23817 INSURER E: Continental Casualty Company 20443 INSURER F: COVERAGES CERTIFICATE NUMBER: 570048691042 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 LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER MMIDD MMDI LIMITS A GENERAL LIABILITY GLUl/Ul/ZUIJ EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea prsunanca $2,000,000 CLAIMS -MADE X❑ OCCUR MED EXP(Any one Pempn) $5,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4,000, 000 X POLICY PRO- LOC Empl Benefit Liab $2,00JECT 0, 000 • AUTOMOBILE LIABILITY CA 51 216 AOS Ol 01 2013 01 01 2014 COMBINED SINGLE LIMIT E $2,000,000 BODILY INJURY( Per person) A X ANY AUTO CA 5196218 01/01/201301/01/2014 BODILY INJURY (Per ocodeng ALL OWNED SCHEDULED MA AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident UMBRELLA IJAB OCCUR EACH OCCURRENCE EXCESS LUIB H CLAIMS -MADE AGGREGATE DEO RETENTION C C WORKEEMPLOSCOMPPEENSATION AND YIN ILMY ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? -1 (Mandatory In NH) NIA A018112603 Cwc WC016112604 FL Ol Ol/2013 O1/O1/2013 01/01/2014 O1/O1/2014 X TORV LIMIATSU OnTH E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 0Y describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2,000,000 E E&Q-PL-Primary 167112912 01/01/2013 01/01/2014 Each wrongful Act $2,000,000 E&O Professional Liab General Aggregate $2,000,000 SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 101, AddlUonal 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 POACHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ON ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORMED REPRESENTATIVE Attn: Ed. BDnnette For Fort N. Mains Collins St. CO 80522 USA n sACY�tasazeat�e�ra t� a� � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ® " o CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 231/2012 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: H 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 Rlsk InsDrance services west, Inc. San Francisco CA Office CONTACT NAME: PHONE (415) 486-7000 FAX (415) 486-0029 INC. No. EAU: NL. Ne.: 199 Fremont Street Suite 1500 E-MAIL ADDRESS: San Francisco CA 94105 USA INSURERS) AFFORDING COVERAGE NAIC e INSURED Adecco Inc. 175 Broad Hollow Road 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 Melville NV 11747-4902 USA INSURER D: ACE American Insurance Company 22667 INSURER E: Continental Casualty Company 20443 INSURER F: XL Insurance America Inc 24554 lgaPlA Fads7l Ia:e l l a UNAI i2111 u1-faaF7l111LS:fA13111L1. :1all 9❑10■J 1110, '0111111 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 WVD POLICY NUMBER MMIDD MIND LIMITS A GENERAL LIABILITY GL EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea pcwRe'.)$2.000, 000 CLAIMS-IAADE EOCCUR MED EXP(Any one permn) $5.000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000, 000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S4,000, 000 X POLICY PRO- LOC A AUTOMOBILE LMBILRY a CA 5196216 01/01/2013 01/01/2014 COMBINED SINGLE LIMIT accident) S2,000,000 BODILY INJURY ( Per person) X MY AUTO ALL OWNED SCHEDULED BODILY INJURY( Per accident) AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON-0WNED AUTOS Paraccident F X UMBRELLALMB X OCCUR US00045047L113A 01/01/2013 01/01/2014 EACH OCCURRENCE SS,000,000 SIR applies per policy terns & condi ions AGGREGATE S5,000,000 EXCESS LIAR CLAIMS -MADE DED I X RETENTION S10, 000 C WORKERS COMPENSATION AND WC018112603 01/01/2013 01/01/2014 WC STATU- OTH- X TORY LIMITS Eft EMPLOYERS' LIABILITY YIN CA E.L. EACH ACCIDENT $2,000,000 D ANY PROPRIETOR I PARTNER/EXECUTIVE Orr CEUMEMBER EXCLUDED? NIA wC018112604 Ol/Ol/2013 01/Ol/2014 E.L. DISEASE -EA EMPLOYEE $2,000,000 (Mandatory In NH) FL It es. descnb under E.L. DISEASE -POLICY LIMIT S2,000,000 DESCRIPTION OF OPERATIONS below E E&O-PL-Primary - 167112912 01/01/2013 01/01/2014 Each wrongful Act 51,000,000 SIR applies per policy ter s & condi ions General Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Atldaional Remarks Schedule, N more space is mquimd) Branch Location: Adecco Technical 4025 Automation Way Suite F1 Fort Collins, CO 80525�i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette 215 N. Mason St. For Fort Collins CO 80524 USA ✓cmJc ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD �I �►v �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM12012 Y) vzgnalz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER A0n R15k In$DfanLe Services West, Inc. San Francisco CA Office CONTACT NAME: PHONE (415) 486-0000 FA% (415} 486-J029 INC. No. E#): (NC. NoJ: E#WL ADDRESS: 199 Fremont Street Suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIL e INSURED INSURER A: Insurance Company Of the State Of PA 19429 Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA INSURER B: National union Fire Ins Co of Pittsburgh 19445 INSURER C: New Hampshire Ins CO 23841 INSURER O: Illinois National Insurance CO 23817 INSURER E: ACE American insurance Company 22667 INSURER F: Continental Casualty Company 20443 lKp•A:IAItl R--�tl9:\rliltll\IailNiJ-f 9:IF�un[r:f =�NNn :Q•Ib�P10�214iJ-f 9:� 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 MPOUCYUP IPOUCYEFF NIDO MMIDDIYYYY1 LIMITS B GENERAL UMILFY GL9645242 EACHOCCURRENCE S2,000,000 % COMMERCIAL GENERAL LNBLITY PREMISES Ea occurrence)$2,000, 000 CLAIMS -MADE X❑OCCUR MEO UP (My one person) S5,000 PERSONAL N ADV INJURY S2,000,000 GENERFLAGGREGATE $4,000, 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG $4,000,000 % POLICY PRO- LOG B e AUTOMOBILE UABILITY -' _ `-' -- - - CA 5196216 CA 5196218 01/01/2013 01/01/2013 0101 2014 01/01/2014 COMBINED SINGLE LIMIT Ea omdent $2,000,000 BODILY INJURY( Per person) % ANY AUTO MA BODILY INJURY(Peracddenl) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NED AUTOS AUTOB PROPERTY DAMAGE Peracddent G X uuaRELULu6 EXCESS LNB H OCCUR CLAIMS -MADE uS00045047L113A SIR applies per policy terns 01/01/2013 & condi 01/01/2014 ions EACH OCCURRENCE $5,000,500 AGGREGATE $5,000,000 DED I X RETENTION f10, 000 A A WORKERS EMP OYER50MP�ENION ANO YIN IIULMY gNYPROPRIETOR/PARTNER/E(ECUrNE OFFICERMEMBER EXCLUDEDi „Mandat (Mandator, N/A CCA018112603 wCB18112604 FL 01/01/2013 01/G1/2G13 01/01/2014 01/01/2014 X TORY LIMBS ERH E.L. EACHACCIOENT $2,000,006 EL. OISEASE£A EMPLOYEE S2,000,000 — 'USCRIPTON OF OPERATIONS oolo '- . " - ELDISEASE-POLN;YUMIP-. — S2,000,000 F E&O-PL-Primary 167112912 01/01/2013 01/01/2014 Each wrongful Act S1,000,000 SIR applies per policy terns & condi ions Agg. each claim f1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ANech ACORD 101, MdlUonal Foments Schedule, a more space la required) Branch Location: Adecco staffing, 3711 JFX Parkway, Suite 305, Fort Collins, Co 80525. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCHES 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 215 N. Mason St. Fort Collins CO 80524 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ,4,c ® l.� CERTIFICATE OF LIABILITY INSURANCE DAT 1M?8120112 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: (NCC.."No. Est): (415) 486-loon FAX No): (411) 486-7029 EJ.WL ADDRESS: 199 Fremont Street Suite 1500 San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Insurance Company of the State Of PA 19429 Adecco Inc. 175 Broad Hollow Road Melville NY 11747 USA INSURER B: National Union Fire Ins CO of Pittsburgh 19445 INSURER C: New Hampshire Ins Co 23841 INSURER D: Illinois National Insurance Co 23817 WSURER E: XL Insurance America Inc 24554 NBURER F. COVERAGES CERTIFICATE NUMBER: 570948535999 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 LTR TYPE OF INSURANCE HER MD POLICY NUMBER MMIDD MIND LIMITS GENERAL LUUMI-MY GL9645242 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eeowunence$2,000,000) CLAIMS -MADE %❑ OCCUR MED E%P(Any one person) $5,000 PERSONAL &ADV INJURY $2,000,006 GENERAL AGGREGATE $4,000.000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $4,000.000 % POLICY PR6 LOC B e AUTOMOBILE LIABILITY CA 5196216 CA 5196218 01/01/2013 01/01/2013 01/012014 01/01/2014 COMBINED SINGLE UMIT m $2,000,000 BODILY INJURY (Per Person) X ANY AUTO MA BODILY INJURY (Per amdent) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NONdWNED AUTOS PROPERTY DAMAGE Per accident) E X UMBRELLA LMB % OCCUR U500045047L113A 01/01/2013 01/01/2014 EACH OCCURRENCE $5,000,000 E%CESS LMB CIAIMSfAADE SIR applies per policy terns & condi ions AGGREGATE $510001000 DEO I X RETENTION$10. 000 A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICEWMEMBER EXCLUDED? (Mandatory in NH) NIA WC018112603 CA w[01$112604 FL 01/01/ 201301/ D1/B1/2013 0 1 / 2014 O1/O1/2014 X TORY LIMITS ERH E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 If 9 d.solhe a„dw DESCRIPTION OF OPERATIONS Iwbw E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Utlach ACORD 101, A4dleonal Ramarts Schedule, B more space is reepired) Branch Location: AdeCCO Engineering & Technical, 300 E. Boardwalk, Fort Collins, CO 80525. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Ed Bonnette For N. Mason St. Fort Collins CO 80524 USA �n rpp�/////� /� t)(7y0/ �(/YL/61K/ i�%' SIT ��r a�R/lGC f6fvd' ✓.U.4 //!4('X= 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 0 n w c m 9 22 0 CERTIFICATE OF LIABILITY INSURANCE IY 229ODDATE(MMr2012 YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AOD Risk insurance services West, Inc. San Francisco C, Office CONTACT NAME: PHON (415) 486-7000 FAX (41$) 486-7029 INC. No. Earl: NC. No.): 199 Fremont Street Suite 1500 EMAIL ADDRESS: San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAICY INSURED Ace ccoInc. Inc. 175 Broad Hollow Road INSURER A: Insurance Company Of the State Of PA 19429 INSURER B: National union Fire Ins CO Of Pittsburgh 19445 INSURER C: New Hampshire Ins Co 23841 Melville NY 11747 USA INSURERD: Illinois National Insurance Co 23817 NSURER E: NSURER I. 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 she" are as requested LTp TYPE OF INSURANCE INSR WVD POIJCY NUMBER POUCY EFF MMJDDrYYYYI POLICY UP IMJNDD1YYYYILIMITS B GENERAL LIABILITY GL EACH OCCURRENCE $2,000, 000 % COMMERCIAL GENERAL LIABILT' PREMISES Ea ortren mce $2, 000, 000 CLNMS_MADE ❑% OCCUR MED UP (My one person) S5,000 PERSONAL B ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000, 000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4,000,000 X POLICY PRO- LOC B AUTOMOBILE LIABILITY CA 5196216 01/01/2013 0110112014 COMBINED SINGLE LIMIT (Ea cciderd 42,000, 000 B CA 5196218 01/01/2013 01/01/2014 BODILY INJURY (Per person) X ANY AUTO MA ALL OWNED SCHEDULED BODILY INJURY (Per eccitlenl) AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED AUTOS Per rudem UMBRELLALMB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-lMBE AGGREGATE DED RETENTION A WORKERS ORKSEMPLOSCOMeo1Nfl�ION AND WC018112603 01/01/2013 01/01/2014 X fl YIN Lq TORVLIMRS ELEACH ACCIDENT $2,000, 000 A P FFPROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? N NIA WC018112604 01/01/2013 01/01/2014 E.L. DISEASE -EA EMPLOYEE $2,000,000 BiWndatory In NM FL DESORIPTe ONN under OF OPERATIONS twb EL.DISEASE OLICYLIMR $2,000,pQQ, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AtltlWpnal Ranurb Schedule, N more.,. la —abed) Branch Location: Adecco Engineering & Technical, 4025 Automation Way FI, Fort Collins, CO 80S25. i 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 AUTHOWED REPRESENTATIVE Attn: Ed BOnnette For N. Mains St. Fort N. Collinsmason CO 80522 USA 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD