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HomeMy WebLinkAbout114084 EXPRESS SERVICES INC - INSURANCE CERTIFICATE (2)ANY 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) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Express Services, Inc. Workers Compensation Policy Schedule: Policy periods: 10/1/18-19 American Home Assurance Company Policy No. WC031467910 NAIC# 19380 States Covered: CA Illinois National Insurance Co. Policy No. WC031467911 NAIC# 23817 States Covered: MA, ND, WI, WY New Hampshire Insurance Company Policy No. WC031467912 NAIC# 23841 States Covered: AL, AR, CO, CT, DC, DE, GA, HI, IA, ID, IN, KS, LA, MD, ME, MI, MN, MO, MS, MT, NE, NM, NV, NY, OK, OR, RI, SC, SD, TN, TX, WV New Hampshire Insurance Company Policy No. WC031467913 NAIC# 23841 States Covered: AK, AZ, IL, KY, NC, NH, NJ, PA, UT, VA, VT Illinois National Insurance Co. Policy No. WC031467914 NAIC# 23817 States Covered: FL National Union Fire Insurance Company of Pittsburgh, PA Policy No. XWC 5565562 NAIC# 19445 States Covered: OH National Union Fire Insurance Company of Pittsburgh, PA Policy No. XWC5565563 NAIC# 19445 States Covered: WA Miscellaneous Attachment: M554393 Master ID: 1352730, Certificate ID: 12499330 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 have ADDITIONAL INSURED provisions or 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960-9000 EXPRESS SERVICES, INC. DBA: EXPRESS EMPLOYMENT PROFESSIONALS 9701 BOARDWALK BOULEVARD OKLAHOMA CITY, OK 73162 EXPSE01 American Guarantee and Liab. Ins. Co. 26247 New Hampshire Insurance Company 23841 Zurich American Insurance Company 16535 X X X STAFFING SERVICE 5,000,000 1,000,000 10,000 5,000,000 5,000,000 5,000,000 X X 1,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X X 20,000,000 20,000,000 XXXXXXX N X 1,000,000 1,000,000 1,000,000 CRIME/FIDELITY STAFFING E&O COVERAGE CRIME/FIDELITY: 5,000,000 AGG E&O OCC/AGG: 5,000,000 B PRA5854213-06 10/1/2018 10/1/2019 B PRA5854213-06 10/1/2018 10/1/2019 B PRA5854213-06 10/1/2018 10/1/2019 C UMB5498877-06 10/1/2018 10/1/2019 A SEE ATTACHED POLICY #'S 10/1/2018 10/1/2019 10/1/2019 1352730 N N N N N N N 9/20/2018 N N 12499330 12499330 XXXXXXX CITY OF FORT COLLINS ATTN: GERRY S. PAUL 215 NORTH MASON STREET FORT COLLINS CO 80521 ALL INSURANCE CARRIERS SHOWN ON THIS CERTIFICATE HAVE AN A.M. BEST RATING OF A XV OR BETTER UNLESS OTHERWISE NOTED. LOCATION: 1016 - FORT COLLINS CO / TYPE OF COMPANY: MUNICIPALITY / JOB DESCRIPTION: GENERAL CLERICAL AND ADMINISTRATIVE SUPPORT POSITIONS. X See Attachment