HomeMy WebLinkAbout126171 VOLT WORKFORCE SOLUTIONS - INSURANCE CERTIFICATEll CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 0i30/2� 5
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 CONTACT
NAME
Willie of New York, Inc. PHONE FAX
c/o 26 Century Blvd. 7 4 -7 78 88- 7-2 78
P. D. Box 305191 AD-MAILDRESS
certificates@willis.com
Nashville, IN 37230
INSURER(S)AFFORDING COVERAGE NAICt
INSURERA: National Union Fire Insurance Company of 19445-002
INSURED
Volt workforce Solutions INSURERS: New Hampshire Insurance Company 23841-001
A Division of Volt Management Corp. INSURE RC: Illinoi a National Insurance Co. 23817-002
7300 West 110th St.,
Commerce Plaza, Ste. 140 INSURER D: National Vaion Fire Insurance Co. of Pitt 19445-001
Overland Park, KS 66210 INSIIRFR P.
COVERAGES CERTIFICATE NUMBER:22997244 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.
TYPE OF INSURANCE
A13INSR. DL
SU
POLICYNUMSER
POLICY EFF
POLICY EXPITR
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
y
GL9575059
/31/2015
3/31/2016
EACH OCCURRENCE
$ 11000,000
PR�IA�EI(tppa
Ecoc�irerma)
$ 250 000
MEDEXP(An oneperaon)
$ 10,000
PERSONAL aADV INJURY
$ 1,000.000
GEN'L
AGGREGATE UMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY JjEECT LOC
PRODUCTS-COMP/OP AGG
$
OTHER:
$
AUTOMOBILE LIABILITY
COMMBINEEnDI31NGLEU IT
$
BODILY INJURY(Per person)
ANY AUTO
$
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY )
(PoreCddeM
$
HIREDAUTOS NON -OWNED
AUTOS
PROPER DAMAGE
(Per aczidenI)
$
S
UMBRELLA LMIS
OCCUR
EACH OCCURRENCE
$
AGGREGATE
EXCESS LIAR
CLAIMS -MADE
$ _
DED I RETENTION$
$
g
B
C
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE®
OFFICER/MEMBER EXCLUDED?
mandatory in NH)
R yes, descnbe under
DESCRIPTIONOF OPERATIONS below
MIA
WCO21459984
WCO21459989
WCO21459986
WCO21459988
/31/2015
3/31/2015
3/31/2015
/31/2015
3/31/2016
3/31/2016
3/31/2016
3/31/2016
Y
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE -EA EMPLOYEE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
B workers Compensation
WCO21459990
31 2015
3 31 2016
See above Workers Compensation
section
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached If more space Is required)
Re: Services Agreement effective November 1, 2012
The City of Fort Collins, its officers, agents and employees are included as Additional Insureds
as respects to General Liability when required by written contract.
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 AUTHOR DR ESENT
Attn: Purchasing
P.O Box 580
Fort Collins, CO 00522
Coll:4655882 Tpl:1935290 Cert:22997244 ® 88-2014ACORDCORPORATION.Allrightsreserved.
ACORD 25 (2014101) The ACORD name and logo are registered ma of ACORD