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HomeMy WebLinkAbout131163 ADECCO INC & ITS SUBSIDIARIES - INSURANCE CERTIFICATE (5)I ® A`OR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03119/2015 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:_ PHONE FAX JA AIC No : E-MAIL ADDRESS: New York, NY 10036 Atbn: Adecco.certs@Marsh.com Fax. 212-948-0018 INSURE S AFFORDING COVERAGE NAIC 0 INSURER A: AXA Insurance Company 370044-ALL-GAUWC-15-16 NO _ _ INSURED Adecco Inc. 8 its subsidiaries10151 Deerwood Park Blvd. INSURER B : National Union Fire Insurance Co Of Pittsburgh 5 INSURER C : Insurance Company Of The State Of PA !133*2 9 INSURER D: National Union Fire Ins. Co. 5 Building 200 Jacksonville, FL 32256 INSURER E : INSURER F : CnVFRAGFS CFRTIFICATF NIIMRFR- NYC-n0667607"6 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDPOLICYIFYYYYMIDD EXP LIMITS A GENERAL LLABIurY PCS002071(15) 0110112015 01101/2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES a occurrent $ 2'000'000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR MED EXP Anyone on) $ 5,000 PERSONAL & ADV INJURY $ 2.000,000 GENERAL AGGREGATE $ 4,000.000 AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGO $ 4,000,000 $ rL PRO- M LOC POLICY X I B AUTOMOBILE LIABILITY X 5874044 (AOS) 01/0112015 01/01/2016 COMBINED SINGLE LIMIT Ea accident 2000WD BODILY INJURY (Per person) $ B X ANY AUTO 5874046 (MA) 01101/2015 01/01/2016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Par=ident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LUIB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ $ C WORKERS COMPENSATION 024508528 (AOS) 01/01/2015 01/01/2016 WC sTAru- oTH- C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDEDO � (Mandatory in NH) N / A 024508532 (CA) 024508533 ( FL) 01/0112015 01/0112015 01/01/2016 0110112016 DENT E.L EACH ACCIEA $ 2'�'� E.L. DISEASE - EMPLOYE $ 2,000,000 IIyes describe ender DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMB 2000000 $ D CRIME 01-8414MY05 1111112114 /510112011 LIMIT 10,000,000 WITH THIRD PARTY COVERAGE $5MI$15M DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location Adecco Engineenng 8 Technical, 300 E. Boardwalk, Fort Collins, CO 80525. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Ann. Ed. Bonnette 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 ©1988-2010 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 A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA. Inc. Adecco Inc. & its subsidiaries 10151 Oeenvood Park Blvd. Building 200 POLICY NUMBER Jacksonville, FL 32256 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. POLICY NUMBER: 024508531 STATE: AKAZ,VA EFFECTIVE: 1I1I2015-111/2016 PAPER INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508529 STATE: IL,KY,NC,NH,UT,VT EFFECTIVE: i/l/2015-1/1I2016 PAPER INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508534 STATE:ME EFFECTIVE: 1/1/2015� 1/112016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER. AIG POLICY NUMBER: 024508536 STATE: MA, ND, WA, WI, WY EFFECTIVE: 11112015-1/l/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508530 STATE:NJ,PA EFFECTIVE: I/IM15-1/112016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER AIG POLICY NUMBER: 024508535 STATE: MN EFFECTIVE: 111120151 /l /2016 PAPER THE INSURANCE COMPANY OF THE STATE OF PA CARRIER AIG EXCESS WORKERS COMP-OHIO ONLY. INSURER: NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: 9883942 EFFECTIVE: 1 /l /2015 11112016 LIMITS: SIR: $3,000,000 EL EACH ACCIDENT I EL DISEASE I EL DISEASE - EACH EMPLOYEE$1,000,0001$1.000.0001$1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD