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HomeMy WebLinkAboutPEOPLEREADY INC - INSURANCE CERTIFICATE,acoRO' CERTIFICATE OF LIABILITY INSURANCE 12020 FDATE(MM/DD/YYYY) 6:13i2019 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). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 (303)414-6000 CONTACT PHONE A/C No Ext : A/C No): EMAIL ADDRESS: uAFFORDING INSURER A: National Union Fire his Co Pitts. PA 19445 INSURED PeopleReady, Inc. 1036748 1015 A. Street PO Box 2910 Tacoma, WA 98401 48837-1999 INSURER B : NEW Hampshire Insurance Company 23841 INSURER C : Insurance Company of the State of PA 19429 INSURER p, American Home Assurance Company 19380 JNSURER COVERAGES CERTIFICATE NUMBER: 13029266 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS 4 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR SIR S 1 M Y N 6862343 7/1/2019 7/1/2020 EACH OCCURRENCE 3,000,000 - PREMISESOEa occur ence 3 000,90 X MED EXP (Any oneperson) XXXXXXX PERSONAL & ADV INJURY $ 3,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC OTHER: GENERAL AGGREGATE $ 5,000,000 PRODUCTS -COMP/OP AGG $ 3,000,000 $ A A A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED ONLY Y N 2991935 (AOS) 2991936 (MA) 2991937 ( A) 7/1/2019 7i 1/2019 7!1/2019 7/l/2020 7/1/2020 7/1/2020 COMBINED SINGLE LIMIT Ea accident $ 3,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $XXXXXXX PROPERTY ac IcdenDAMAGE $ XXXXXXX $XXXXXXX A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 28295164 1 7/1/2019 7/1/2020 EACH OCCURRENCE $ 25 0 00 000 AGGREGATE $ 25,000,000 DED I I RETENTION $ $ XXXXXXX t3 C D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIE R/PARTNER/EXECUTIVE OFFICERlMEMBEREXCLUDED? � (Mandatory in NH) be under DESCRIPTION OF OPERATIONS below N/A N 14649290, 14649284, 14649287 14649293, 14649288, 14649286 14649296 7/1/2019 7/1/2019 7/1/2019 7/11/2020 7/1/2020 7/1/2020 PER OTH. X STATUTE E E.L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT 11 1,000,000 A Excess Work Comp N N 5565626-QSI 7,1 2019 7 1 3()30 SIR S350,000 each accident DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The above coverages apply only to temporary employees dispatched to do work on behalf of the Named Insured. City of Fort Collins is included as Additional Insured if required by written contract between the Named Insured and City of Fort Collins as respects General and Auto Liability. �r%i Irl . mI C nv LUCR 1L.A1NL,=LLAI IVN aee ATTacnirnenTs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13028266 AUTHORIZED REPRESENTATIVE City of Fort Collins PO Box 580 Fort Collins, CO 80522 ACORD 25 (2016/03) ©1988-20 5 ACORb CORP RATION. All riahts rp SPry Pri The ACORD name and logo are registered marks of ACORD