Loading...
HomeMy WebLinkAbout131163 ADECCO INC & ITS SUBSIDIARIES - INSURANCE CERTIFICATE (2)® DATE(MM/DDIYYYY) .4COR0 CERTIFICATE OF LIABILITY INSURANCE 04/28/2015 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 CONTACT Marsh USA, Inc. NAME: PHONE FAX 1166 Avenue of the Americas (A/C No. Ext): Alc No New York, NY 10036 E-MAIL Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 370044-ALL-ALL-15-16 NO INSURER A: AXA Insurance Company 33022 INSURED INSURER B: National Union Fire Insurance Co Of Pittsburgh 19445 Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. INSURER C : Insurance Company Of The State Of PA 19429 Building 200 INSURER D : NIA N/A Jacksonville, FL 32256 r`nVCRAnG¢ r`FRTIFICATF NII IMRFP- NYC-006685060-07 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 SUBR POLICY NUMBER MM DPO_LI DYYYY MM/DD YYYY LIMITS A GENERAL LIABILITY PCS002071(15) 01/01/2015 01/01/2016 EACH OCCURRENCE $ 2,000,000 MMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE �I OCCUR I- PERSONAL & ADV INJURY $ 2,000,000 PXCONTRACTUAL LIABILITY GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 4,000,000 $ X I POLICY X PRO- X LOC B AUTOMOBILE LIABILITY 5874044 (AOS) 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT Ea accident) 2,000,000 BODILY INJURY (Per person) $ B X ANY AUTO 5874046 (MA) 01/01/2015 01/01/2016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ L A X UMBRELLA LIAB X OCCUR XS002072(15) 01/01/2015 01/01/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ C WORKERS COMPENSATION 024508528 (AOS) 01/01/2015 01/01/2016 X I WC STATU- OTH- CRYI FIR LIMITS 1 C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N / A 024508532 (CA) 024508533 FL ( ) 01/01/2015 01/01/2015 01/01/2016 01/01/2016 E.L. EACH ACCIDENT $ 2,000,000 E L. DISEASE - EA EMPLOYE 2,000,000 $ E L DISEASE - POLICY LIMIT 2,000,000 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below A E&O AND NETWORK SECURITY PCS002073(15) 01/01/2015 01/01/2016 EA. CLAIM/AGG(SIR $500,000) $5M/$5M PRIVACY EVENT EXPENSE 'PROFESSIONAL LIABILITY' EA. CLAIM/AGG (SIR $250,000) $2.5M1$2.5M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location Adecco Engineering & Technical, 4025 Automation Way F1, Fort Collins, CO 80525. f`COrICIr`ArC unl nco rANrFI I ATInPJ City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Ed Bonnette THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason St. ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke V 1Vt%IJ-LUTU AL UKU %,UK1-VKA I IVIY. All rigntS reSerVett. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York ACORL�� ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. Building 200 POLICY NUMBER Jacksonville, FL 32256 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: POLICY NUMBER: 024508531 STATE: AK,AZ,VA POLICY PERIOD: 1/l/2015- 111/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508529 STATE: I L, KY, N C, N H, UT, VT POLICY PERIOD: i/112015- 1/i/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508534 STATE:ME POLICY PERIOD: 111I2015- 111I2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508536 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 1/112015- 111/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508530 STATE: NJ, PA POLICY PERIOD: 11112015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508535 STATE: MN POLICY PERIOD:1/1/2015- 111I2016 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 POLICY PERIOD: 11112015- 1/1/2016 LIMITS: SIR:$3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York AC"R ® ADDITIONAL REMARKS SCHEDULE L _—� Page 3 of 3 AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. Building 200 POLICY NUMBER Jacksonville, FL 32256 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM 1008374-00 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 05/01/2015-05/01/2016 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 ACORD 101 (2008/01) U zoos ACUKU CUKFUKA I IUN. All rlgnts reservea. The ACORD name and logo are registered marks of ACORD