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HomeMy WebLinkAbout130882 LABOR READY - INSURANCE CERTIFICATE (4)ACURD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 /2016 6/29/2015 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 Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 CONTACT NAME: HONE AX A/C, No, Ext : A/C, No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # (303) 414-6000 INSURER A: National Union Fire Ins Co Pittsbur_h PA 19445 INSURED Labor Ready 1036748 (See Attached Named Insured Schedule) 1015 A Street INSURER B: New I lam shire Insurance Company 41 INSURER c : Insurance Company of the state of PA 19429 INSURER D : PO Box 2910 INSURER E : Tacoma, WA 98401 48837-1999 INSURER F COVERAGES TRUBL02 CERTIFICATE NUMBER: 113029166 RFVISInN NI IMRFR• 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 3333125 7/1/2015 7/1/2016 EACH OCCURRENCE 1,000000 CLAIMS -MADE � OCCUR PREMISES (ERENTED r nce) $ 1,000,000 X MED EXP (Any oneperson) XXXXXXX SIR $ I M PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000 000 POLICY❑ JJECT LOC Pq PRODUCTS -COMP/OP AGG $ 3,000,000 OTHER A AUTOMOBILE LIABILITY Y N 3030977(AOS) 7/1/20I5 7/1/2016 EOaaBIN SINGLE $ 1,000,000 A A X ANY AUTO 3030979 (VA) 3030978(MA) 7/1/2015 7/1/2015 7/1/2016 7/1/2016 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ XXXXXXX $XXXXXXX A X UMBRELLA LIAB I]( OCCUR N N 19962018 7/I/2015 7/1/2016 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ IN/A $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N 21942898, 21942924 - AOS 7/1/2015 7/1/2016 X STATUTE FIR g (. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 21942902-CA; 21942906-FL ? 1942909-MA: 21942919-OR 7/1/2015 7/1/2015 7/1/2016 7/1/2016 E L EACH ACCIDENT n $ 1 ,l/00,000 E.L. DISEASE - EA EMPLOYEE Is 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1-000-000 B Workers Compensation Cont'd N N 21942912 - ME, 21942915-MN 7/1/2015 7/1/2016 WC - Statutory, EL Limit $1,000,000 A Excess Work Comp 9884000-QSI 7/1/2015 7/I/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The above coverages apply only to Temporary Labor Ready employees dispatched to do work on behalf of the Certificate Holder. City of Fort Collins is named as Additional Insured if required by written contract between Labor Ready and City of Fort Collins as respects General and Auto Liability. �TN t 11 n1 .m t t= nvLu F_rc i-AIVI.CLLA I IUN Jee /ittacnment5 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 C ACORD 25 (2014/01) ©1 8 2014 A'ORD CORPO ATION. All rights reserved Th. AC()Rrl name and Innn ern rnnic4arori nri of Ar(,)P l SCHEDULE OF NAMED INSUREDS Labor Ready Affiliates' Labor Ready Entity Labor Ready Northeast, Inc. Labor Ready Southeast, Inc. Labor Ready Mid -Atlantic, Inc. Labor Ready Central, Inc. Labor Ready Midwest, Inc. Labor Ready Northwest, Inc. Labor Ready Southwest, Inc. Labor Ready, Inc. Labor Ready Holdings, Inc. Spartan Staffing, LLC Spartan Staffing Puerto Rico, LLC PTPR, Inc. Job Rooster, Inc. Centerline Drivers, LLC Venue Ready, LLC PlaneTechs, LLC Drivers on Demand, LLC TrueBlue Enterprises, Inc. TrueBlue Inc. PAC TransTechs Miscellaneous Attachment : M 19451 Master ID: 1036748, Certificate ID: 13028266 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M. 07/01/15 forms a part of Policy No. 3333125 Issued to Labor Ready Northeast, Inc.; Labor Ready Southeast, Inc.; Labor Ready Mid -Atlantic, Inc.; Labor Ready Central, Inc.; Labor Ready Midwest, Inc.; Labor Ready Northwest, Inc.; Labor Ready Southwest, Inc.; Spartan Staffing, LLC; Venue Ready, LLC; PlaneTechs, LLC; TransTechs; Project Trade Solutions, LLC; & Centerline Drivers, LLC and GL 7267017 CLP Resources, Inc.; Spartan Staffing, LLC; CLP Resources, Inc.; Centerline Drivers, LLC; PlaneTechs, LLC; & Venue Ready, LLC By National Union Fire Insurance Company ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED, is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability caused in whole or in part: A. by your acts or omission in the performance of your ongoing operations; or B. in connection with your premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: • The coverage and/or limits of this policy, or • The coverage and/or limits required by said contract or agreement. Miscellaneous Attachment : M56029 Certificate ID : 13028266