Loading...
HomeMy WebLinkAbout130882 LABOR READY CENTRAL INC - INSURANCE CERTIFICATEANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SCHEDULE OF NAMED INSUREDS Labor Ready Affiliates' 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 Miscellaneous Attachment: M19451 Master ID: 1036748, Certificate ID: 13028266 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M. 07/01/14 forms a part of Policy No. 7267016 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; Venue Ready, LLC; PlaneTechs, LLC; TransTechs; Project Trade Solutions, LLC; & Centerline Drivers, LLC and GL 7267017 CLP Resources, Inc.; Spartan Staffing, LLC; CLP Resources, Inc.; Centerline Drivers, LLC; PlaneTechs, 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: x The coverage and/or limits of this policy, or x The coverage and/or limits required by said contract or agreement. Miscellaneous Attachment: M56029 Certificate ID: 13028266 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 Labor Ready (See Attached Named Insured Schedule) 1015 A Street PO Box 2910 Tacoma, WA 98401 48837-1999 TRUBL02 Insurance Company of the State of PA 19429 National Union Fire Ins Co Pittsburgh PA 19445 New Hampshire Insurance Company 23841 X X X Per Proj. Agg - $1M X SIR $1M 1,000,000 1,000,000 XXXXXXX 1,000,000 5,000,000 3,000,000 X 1,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X 5,000,000 5,000,000 XXXXXXX N X 1,000,000 1,000,000 1,000,000 Workers Compensation Cont'd Excess Work Comp WC - Statutory; EL Limit $1,000,000 A 7062912 7/1/2014 7/1/2015 A 7062913 7/1/2014 7/1/2015 A 7062914 7/1/2014 7/1/2015 A 7267016 7/1/2014 7/1/2015 B 86476614-ME; 86476615-MN 7/1/2014 7/1/2015 A 6636307-QSI 7/1/2014 7/1/2015 A 49131421 7/1/2014 7/1/2015 B 86476607; 86476608 7/1/2014 7/1/2015 B 86476610; 86476609-AOS 7/1/2014 7/1/2015 B 86476611-CA; 86476612-FL 7/1/2014 7/1/2015 C 86476613-MA; 86476616-OR 7/1/2014 7/1/2015 7/1/2015 1036748 Y N Y N N N N 7/14/2014 N N 13028266 13028266 XXXXXXX City of Fort Collins PO Box 580 Fort Collins, CO 80522 The above coverages apply only to Temporary Labor Ready employees dispatched to do work on behalf of the Certificate Holder. City of Fort Collins is named as Additional Insured if required by written contract between Labor Ready and City of Fort Collins as respects General and Auto Liability. X See Attachments