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HomeMy WebLinkAbout131163 ADECCO INC & ITS SUBSIDIARIES - INSURANCE CERTIFICATE (6)' 1 a DATE (MM/DD/YYYY) ACORO 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: 1166 Avenue of the Americas A/C. No. Ext): _ _ IONE n/c, Not: 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 INSURER E: INSURER F : r•/1VCO Ar_CC r`FATILIr`ATF NI IMRF97• NYr.-n0A67Fn75-n7 RFVISION NIIMRFR' 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 VVITH 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 POLICY EFF MMlDDlYYYY POLICY EXP MM/DDlYYYY LIMITS A GENERAL LIABILITY PCS002071(15) 01/01/2015 01/01/2016 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 -I CLAIMS -MADE u OCCUR PERSONAL & ADV INJURY $ 2,000,000 X CONTRACTUAL LIABILITY GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 4,000,000 $ X POLICY X PRO- X LOC B AUTOMOBILE LIABILITY X 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 PROPERTYDAMAGE $ — A X UMBRELLA LIAB X OCCUR XS002072(15) 01/01/2015 01/01/2016 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAR C_LAIMS-MADE $ _ DIED I X I RETENTION $ 10'000 C WORKERS COMPENSATION 024508528(AOS) 01/0112015 01(01/2016 X WCS ATu- OTH- C C AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 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. CLAIWAGG(SIR $500,000) 10,000,000 PRIVACY EVENT EXPENSE 'PROFESSIONAL LIABILITY' EA. CLAIM/AGG (SIR $250,000) $51vl$15M DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins, CO 80525. CFRTIFICATF HOLDER CANCELLATION City of Fort Collins Attn: 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 U 19S8-ZU1U AGUKU GUKPUKA I IUN. All rlgnts reserVea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York AC " 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: AUUI I IUIVAL KtMAKr b FS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: POLICY NUMBER: 024508531 STATE: AK,AZ,VA POLICY PERIOD: 1/1/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508529 STATE: IL, KY, NC, NH, UT,VT POLICY PERIOD: 111/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508534 STATE:ME POLICY PERIOD: 1/1/2015- 1I1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER AIG POLICY NUMBER: 024508536 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 1/1/2015- 1/l/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508530 STATE: NJ, PA POLICY PERIOD: 1/1/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER. 024508535 STATE: MN POLICY PERIOD:1/1/2015- 1l1/2016 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 POLICY PERIOD: 1/1/2015-1/l/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 ,A�oRL7® ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. POLICY NUMBER Building 200 Jacksonville, FL 32256 CARRIER NAIC CODE EFFECTIVE DATE: AUUI I IUNAL KtMAKK, [IS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, F0ORM NUM BER: 25 FORM TITLE: Certificate of Liability Insurance CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM 1008374-00 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 0510l/2015-0510112016 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 ACORD 101 (2008/01) U 1UUS AGUKU LUKrUKA I IUN. Au rrgnrs reserves, The ACORD name and logo are registered marks of ACORD 1 a DATE (MM/DDNYYY) .4C - 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. ExU: talc, Not: New York, NY 10036 E-MAIL Attn: Adecco.certs(a,Marsh.com Fax: 212-948-0018 ADDRESS: _ 370044-ALL-ALL-15-16 INSURED Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. Building 200 Jacksonville, FL 32256 _ INSURERS AFFORDING COVERAGE NAIC # NO INSURER A: AXA Insurance Company 33022 INSURER e : National Union Fire Insurance Co Of Pittsburgh 19445 INSURER c : Insurance Company Of The State Of PA 19429 INSURER D : N/A NIA rnvcoAnGc CGRTICICATF AIIIMRFR• NYr._nnAAArn5A-n7 RFVISIAN NIIMRFR-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 INSURANCEINS& ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY PCS002071(15) 01/01/2015 01/01/2016 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 1Fa occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE Efl OCCUR PERSONAL & ADV INJURY $ 2,000,000 X CONTRACTUAL LIABILITY GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 $ P X POLICY X RO- 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 TYDAMAGE accident) $ 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 X RETENTION $ 1Q000 $ C WORKERS COMPENSATION 024508528 (AOS) 01/01/2015 01/01/2016 X WC STATU- OTH- I TORY LIMITS FP C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A 024508532 (CA) 024508533 (Fl) 0110112015 01101/2015 01/01/2016 01/01I2016 E.L. EACH ACCIDENT 2,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below A E&O AND NETWORK SECURITY PCS002073(15) 01/01/2015 01/01/2016 EA. CLAIMIAGG(SIR $500,000) $5M/$5M PRIVACY EVENT EXPENSE 'PROFESSIONAL LIABILITY' EA. CLAIWAGG (SIR $250,000) $2.5W$2.5M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Branch Location, Adecco Staffing, 3711 JFK Parkway, Suite 305, Fort Collins, CO 80525, CERTIFICATE HOLDER CANCELLATION City of Fort Collins Attn: Ed Bonnette 215 N. Mason St. Fort Collins, CO 80524 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 AIR 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: ITHIS 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: 1/1/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508529 STATE: IL, KY, NC, NH, UT,VT POLICY PERIOD: 1/l/2015- 1/112016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508534 STATE:ME POLICY PERIOD: 1/l/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508536 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 1/1/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508530 STATE: NJ, PA POLICY PERIOD 1/1/2015- 1/1/2016 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 024508535 STATE:MN POLICY PERIOD:1/1/2015- 1/112016 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: 1l1/2015- 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 4c" ® ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. POLICY NUMBER Building 200 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 CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM 1008374-00 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 05/01/2015-05/0112016 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 Page 3 of 3 ACORD 101 (2008/01) V LUU?J AL.UKU I.UKYUKA I IUIY. All rigntS re`Sevvvu, The ACORD name and logo are registered marks of ACORD