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HomeMy WebLinkAbout131163 ADECCO INC & ITS SUBSIDIARIES - INSURANCE CERTIFICATEACORO ® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) ovoarzal4 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 INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: R 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 Marsh USA, Inc. 1166 Avenue of the Amencas CONTACT NAME: — - FAX PHONE End, _ _ C o New Yak, NY 10036 Am: Adecco.certs@Marsh.corn Fax. 212-948-0018 E-MAIL A INSURERISI AFFORDING COVERAGE NAIC/ INSURER A: AXA Insurance Company 33022 370044-ALL-GAUWC-14-15 NO INSURED ' ! Adecco Inc. 8 its subsioanes (V-, 175 Broad Hollow Road Melville, NY 11747A902 INSURER B : WA WA INSURER C l*RU"M Company Of The Stata Of PA 19429 INSURER D: WA WA INSURER E: INSURER F : COVERAGES CFRTIFICATF NUMBER: NYC-006685058-03 REVISION NUMBER: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. INSR TYPE OF INSURANCE POLICY NUMBER P� EFF felr ICY EXP OMITS A GENERAL LIABILITY X COMMERCULL GENERAL LIABILITY CLAIMS -MADE a OCCUR PCS002071(14) 0110112014 01/01/2015 EACH OCCURRENCE E 2,000,000 RENTED NT€D R avu nc E zwo,000 MED EXP one E NA PERSONAL &ADV INJURY E 2'000'000 GENERAL AGGREGATE S 4,000,000 GENL AGGREGATE X POLICY LIMIT APPLIES PER: X PRO- XJFCT LOC PRODUCTS -COMP/OPAGG It4.000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS-0 NONNMED HIRED AUTOS AUTOS COMBINED ING LIMI accidantl BODILY INJURY (Par Partner) S BODILY INJURY (Per ac=CW X) E PPROPERTY DAMAGE S E UMBRELLA LIAR EXCESS UA13 OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED RETENTIONS 4 G C C C WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/ N OFFICERIMEMBER EXCLUDED? ❑N (Mff andatory In NH) DESCRIPTION OF OPERATIONS Mi. NIA WC043408999 (ADS) WC043409002 AK,AZ,GA,VA ( ) WCD43409007(MA,ND,WA,WLWY) WC043409003 (CA) 01/01/2014 01/0112014 0110112014 0110112014 0110112015 01/0112015 0110112015 01/01/2015 XWC ETATU- OTH- LIMITS FIR E.L. EACH ACCIDENT 2,000,OOo S E.L. DISEASE -EA EMPLOYE E 2,01)0000 E.L. DISEASE -POLICY LIMIT E 2000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Almon ACORD 101, Additional Rome*& Schedule, If man apace Is regWnd) Branch Location: Adecco Staffing, 3711 JFK Padoeay, Suite 305, FM Collins, CO 80525. City of Fort Collins Attn: Ed Bonnette 215 N. Mason St. Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke ACORD 25 (2010/05) CC)'19RR-2010 ACORD The ACORD name and logo are registered marks of ACORD rights reserved. AGENCY CUSTOMER ID: 370044 LOC #: New York AGENCY Marsh USA, Inc. POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE Page 2 of 2 NAIC CODE NAMED INSURED Adeeco Inc & Its subsidiaries 175 Broad Hollow Road Melville. NY 11747,1902 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance WORKERS COMP CONTINUED. INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409004 (FL) EFFECTIVE DATE: 1112014 EXPIRATION DATE: 1/1/2015 INSURER'. INSURANCE CI POLICY NUMBER: WC043 EFFECTIVE DATE: 1/11201 EXPIRATION DATE: 1/112C INSURER: INSURANCE Cl POLICY NUMBER: WC043 EFFECTIVE DATE: 1111201 EXPIRATION DATE: 1112C INSURER: INSURANCE C( POLICY NUMBER: WOD43 EFFECTIVE DATE: 1/1201 EXPIRATION DATE: LIMA INSURER INSURANCE C( POLICY NUMBER: WC043 EFFECTIVE DATE: 111201 EXPIRATION DATE: 11120 EXCESS WORKERS COW INSURER NATIONAL INS POLICY NUMBER. WC6631 EFFECTIVE DATE: 111/201 EXPIRATION DATE: 11120 LIMITS: SIR: S3,000,00) EL EACH ACCIDENT: $1.01 EL DISEASE: $1.00D,000 EL DISEASE - EACH EMIR. ACORD 101 (2008101 1 ® ACORO CERTIFICATE OF LIABILITY INSURANCE III DATE (MMIODIYYYY) 01103/2014 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 Marsh USA, Inc. 1166 Avenue of the Americas CONTACT NAME: NAME: PHONFAX - -.Not New Yak, NY 10036 Atin: Adecco.cerfs@Marsh.can Fax: 212-946-0018 E-MAIL ADONESS INSURI AFFORDING COVERAGE NAIL 0 INSURERA: AXA insurance Company, 33022 370044-ALL-GAUWC-14-15 No INSURED AdeccINSURER o Inc. 8 its subsidiaries 75 175 Broad Hollow Road B: National Union FIB Insurance CO Of Pittsburgh 19445 INSURER C Insurance Company Of The State Of PA 19429 INSURER 0: National Union Fire Ins. Co. Melville, NY 11747A902 INSURER E : INSURER F : r^"= aar_EO CERTlelr.ATE UUMOIE x• NYC-mR87807Sn3 REVISION NUMBER: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 NTH RESPECT TO VIMICH 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. INTSRR TYPE OF INSURANCE POLICY NUMBER NADDL M/ODrfYYYY POLICY EKP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—XI OCCUR PCS002071(14) 0110112014 01/0112015 EACH OCCURRENCE S 2.000.000 DAMAGE TO E S 2.000,000 MED EXP (Any onepawn) i NA PERSONAL& ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY X I PRO- J( LOD PRODUCTS - COMP/OP AGG S 4,000,000 $ 8 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X 'CA 7062785(AOS) CA 7062787(MA) 01101112014 OV0112014 011012015 01/01/2015 COMBINED SINGLE LIMIT no 11 200000D BODILY INJURY (Per portion) S BODILY INJURY (Par socklen) 3 PROPERTY DAMAGE Par S S UMBRELLA LIAR EXCESS DAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE Is DELI I I RETENTION S D D D C WORKERS COMPENSATION m AND EMPLOYERS' LIABILYIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? F±1 (Myanclatory in NH) DESCRIPTION OPERAtION$ below MIA 3408999 (AOS) V C043409002 ( AKAZ,GA,VA) WC043409007 MA,ND,WA,WI,WY) ( WC043409003 (CA) 01 1 1 01/0112D14 01/012014 01/012014 1/0112015 01/0112015 0110112015 01/012015 WC sTATu- 07H - E.L. EACH ACCIDENT 2,000,000 $ E.L. DISEASE -Ell EMPLOYE S 2,000,000 E.L. DISEASE - POLICY LIMIT _ $ 2,000,000 D CRIME 01-841-80-05 01/012014 011012015 LIMIT 10,000,000 $5w$15M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Anetbonel Remarts Schaduw, If mon apace la rap Bred) Branch Location: Adecco Engineering & Tedlnnl, 300 E. Boardwalk, Fort Collins, CO 80525. City of Fort Collins Attu: Ed. Bonnete 215 N. Mason St. 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke J {�� — 1988-2010 ACORD CORPORATION. All rights ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York acoRo® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA, Ind. NAMEDINSURED AdeCCo I(IC & JS Subsidiaries 175 Broad Hollow Road Melville, NY 11747-4902 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409l (FL) EFFECTIVE DATE: 1/1/2014 EXPIRATION DATE: 111/2015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409D00 (IL,KY,NC,NH,UT,VT) EFFECTIVE DATE: 1112014 EXPIRATION DATE: 1/1/2015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409005 (ME) EFFECTIVE DATE: 1112014 EXPIRATION DATE: 111/2015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WOD43409001 (NJ, PA) EFFECTIVE DATE: 1/112014 EXPIRATION DATE: 1/12015 INSURER INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043 09006 (MN) EFFECTIVE DATE: 111QD14 EXPIRATION DATE: 1/112015 INSURER: NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC6636254 EFFECTIVE DATE: V12014 EXPIRATION DATE: 1/12015 LIMITS: SIR: $3,000,0M EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000.000 EL DISEASE - EACH EMPLOYEE: $1,000,000 ACORD 1131 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AvR)P CERTIFICATE OF LIABILITY INSURANCE DATE01103201412014 YYYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER Marsh USA, Inc, 1166 Avenue of the Americas New Yak, NY 10036 Am: Adecco.certs@Marsh.can Fax: 212-948-0018 CONTACT NAME: PHONE FAX No E-MAIL MD AIL INSURER(S) AFFORDING COVERAGE NAM:S INSURER A: AXAlinsurance Company 33922 370044-ALL-GAUWC%15 NO INSURED 5 Inc. & Its subsidiaries 17$ Bo foad HOIk1w Road INSURER 6: National Union FMB Insurance CO Of P81sburgh 944 15 INSURER C Irsura.me Company Of The State Of PA 19429 INSURER D: N/A WA Melville, NY 117474902 INSURER E INSURER F : ='E"GES CERTWICATIE NUMBER* NYC-01166A5060J13 REVISION NUMBER:1 v 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER MM Dr EFF POKY EXP LIMITS A 701AL LU "I" X COMMERCIAL GENERAL LIABILITY CLAIMSMADE a OCCUR PCS002071(14) 0110114014 0110112015 EACH OCCURRENCE $ 2.000,000 I Ea o S 2,000,0W MED E%P (An one S PERSONAL S ADV INJURY S 2,000,000 GENERAL AGGREGATE S 4,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER'. X PRO- X JECT LOC PRODUCTS-COMP/OP AGG $ 4.000,000 S B B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS NOON-OVMED HIRED AUTOS AUTOS CA 7062785 (ADS) CA 7062787 (MA) 0110112014 01101/2014 01/01/2015 01/01/2015 COMBINED SINGLE LIMIT (Ee sooklenU 2 OOD Dpp _ BODILY INJURY (Per person) $ BODILY INJURY (Per accklent) S PROPERTY DAMAGE My I S S A X UMBRELLA LIAR EXCESS DAB X OCCUR CLAIMS -MADE XS002072(14) 01AN/2014 01/0112015 EACH OCCURRENCE S 5,000.000 AGGREGATE S 5,000,000 DIED I X I RETENTION $10,000 S C C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERrEXECUDVE YIN OFFICERIMEMBER EXCLUDED9 ❑N (Mandatory In NH) If m d `ilhe under =ON OF OPERATIONS belowWC043409003 MIA WC043408999 (AOS) WC043409002 AK,AZ,GA,VA) ( WC043409007 MA,ND,WA,WI,WY) ( (CA) 01101014 0110112014 01/0112014 01/01/2014 01/011201$ 01/01/2015 01/01/2015 01101/2015 X I WC STATU- I OTH- E.L EACH ACCIDENT 2,000,000 S E.L. DISEASE -EA EMPLOYE S 2,000,000 E.L. DISEASE -POLICY LIMIT S 2,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Atbeh ACORD 101, AddlUonal Remarks Schedule, If more spsce N wNful w) Branch Locations Adecco Engineering 8 Technical, 4025 Auloma6on Way F1, Fon Collins, CO 80525. City of Fort Collins Attn: Ed BonrMme 215 N. Mason St. FM 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke 3 Aft -0-4=2 _ © 1988-2010 ACORD CORPORATION. All rights ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York ACOP� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA, Inc NAMEOINSURED Adeccu Inc. & its subsidiaries 175 Broad Hollow Road McWille, NY 117474902 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance WORKERS COMP CONTINUED: INSURER INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409004 (FL) EFFECTIVE DATE: 1/112014 EXPIRATION DATE: 1/l2015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC04340M (IL,KY,NGNH,UT,VT) EFFECTIVE DATE: 1/12014 EXPIRATION DATE: 1/112015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WOD43409DD5 (ME) EFFECTIVE DATE: 1/1/2014 EXPIRATION DATE: 1/12015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409001 (NJ, PA) EFFECTIVE DATE: 1/12014 EXPIRATION DATE: 1N2015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409M (MN) EFFECTIVE DATE: 1112014 EXPIRATION DATE: 1/1/2015 INSURER: NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC6636254 EFFECTIVE DATE: 1/112014 EXPIRATION DATE: 11112016 LIMITS: SIR: E3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO CERTIFICATE OF LIABILITY INSURANCE I DAMJUUDDNYYY) 01/0312014 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. N 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 endorsementlsl. PRODUCER Marsh USA, Inc. 1166 Avenue of the Americas CONTACT NAME__ PHONE New York, NY 10036 EMAIL Ann: Adecco.ceds@Marsh.com Fax: 212-948-0018 370044-ALL-GAUWC-14-15____ NO INSURER A: AM INSURED Adecco Inc. 8 45 suhsidiades INSURERS: WA INSURER C : IMu 175 Broad Hollow Road Melville, NY 11747-4902 ..,.,,ewe.,. WA COVERAGES CERTIFICATE NUMBER: NYC-00668505"3 RFVIRIr1N NI IrJI 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. INSR TYPE OF INSURANCEADDL SUM POLICY NUMBER POLICY EFF MM! POLICY Ex MMI 1111R8 A GENERAL LIABILITY PCSDD2071(14) 01/0112014 01IOV2015 EACH OCCURRENCE S 2,WO,000 X COMMERCIAL GENERAL LABILITY FqOCCUR DAMAGE TO RENTED E PREMISESCLAIMS-MADE $ 2000,000 MED EXP (Any one personl 6 NA PERSONAL& ADV INJURY S 2.000,000 GENERAL AGGREGATE S 4,000,000 GEN'L AGGREGATE LMR APPLIES PER PRODUCTS -COMPIOP AGG $ 4,000,000 7 POLICY X PRO- X LOC $ AUTOMOBILE LIABILITY EOM���EDISINGLE LIMIT BODILY INJURY (Per parson) $ ANY AUTO ALL AUTOSAUTOS OWNED SCHEDULED BODILY INJURY (Per sockbnl) S HIRED AUTOS NON -OWNED AUTOS PR PERTYDAMAGE par RoWent)S S UMBRELLA LUIB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAMS -MADE DED RETENTIONS $ C WORKERS COMPENSATION WC043408M(ADS) 01101014 0110112015 X IVIC STATU- DTH- U U C AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandstory In NH) H yes tlasaloe untler DESCRIPTION OF OPERATIONS OeIow NIA WC013409002 (AK,AZ,GA,VA) WC043409007 (MA,ND,WA,WI,WV) WC043409003(CA) 01/0172014 01/01/2014 0110112014 01101Q015 01101/2015 01101IM15 E.L. EACH ACCIDENT $ 2,000.6 E.L. DISEASE- EA EMPLOYE $ 2'000.000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ABsch ACORD 101, Atltlltlonal Remarks Schadule, If mom space Is required) Branch Location. Adecco Engineering & Technical, 300 E. Boardwalk, Fan Collins, CO 80525. City of Fort Collins AtIn. Ed Bonnene 215 N. Mason St. Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke - 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York 4C0 O® ADDITIONAL REMARKS SCHEDULE AGENCY Marsh USA, Inc POLICY NUMBER CARRIER NAIC CODE NAMED INSURED Adecco Inc. d its subsidiaries 175 Broad Hollow Road Melville, NY 117474902 EFFECTIVE DATE: Page 2 of 2 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance 11 WORKERS COMP CONTINUED: INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409004 (FL) EFFECTIVE DATE: 1/1/2014 EXPIRATION DATE: 1112015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409000 (IL.KY,NC,NH,UT,VT) EFFECTIVE DATE: 1/112014 EXPIRATION DATE: 11112015 INSURER INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WOD43409005 (ME) EFFECTIVE DATE: 1/12014 EXPIRATION DATE: 1/12015 INSURER: INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409001 (NJ, PA) EFFECTIVE DATE: 1/112014 EXPIRATION DATE: Irl2015 INSURER. INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC043409006 (MN) EFFECTIVE DATE. 1112014 EXPIRATION DATE. 1112015 EXCESS WORKERS COMP: INSURER NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: WC%X254 EFFECTIVE DATE: 1/1014 EXPIRATION DATE: 1/112015 UMITS: SIR: f3,0D0,000 EL EACH ACGDENT: $1,000000 EL DISEASE: $1.000.000 EL DISEASE - EACH EMPLOYEE: f000,1100 Arnon 4nq ronnmm� Cc) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD