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HomeMy WebLinkAbout112967 G & K SERVICES - INSURANCE CERTIFICATEAFROF CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/2312015 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 NAME: Marsh USA Inc. PHONE FAX 333 South 7th Street, Suite 1400 to c_No, €vtk AIc No): _ E-MAIL ADDRESS: Minneapolis, MN 55402-2400 Attn. Minneapolis.CertRequest@marsh.com Fax 212-948-0114 INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 008 INSURED G&K Services, Inc. and its Subsidiaries INSURER B : N/A N/A INSURER C : Indemnity Insurance Company of North America 43575 5995 Opus Parkway, Suite 500 INSURER D : Great American E&S Insurance Company 37532 Minnetonka, MN 55343 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-006430381-02 REVISION NUMBER:2 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. tNSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG27402744 12/01/2015 12/01/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES a oc Ecurrence $ 1,000.000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY GENERAL AGG $ 15,000,000 X OTHER: Policy General Aggregate A AUTOMOBILE LIABILITY ISAH08866387 12/01/2015 12/01/2016 COMEaaccidentSBINED INGLE LIMIT $ 3,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A WLRC48597154 (AOS) (incl Stop Gap ND, OH, WA & WY ) WLRC48597191 AZ, CA, MA ( ) 12/01/2015 12/01/2015 12/01/2016 12/01/2016 H X STATUTE OER E.L. EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 If Dyes, describe under DESCRIPTION OF OPERATIONS below Workers CompIs not provided in TX E.L. DISEASE -POLICY LIMIT $ 1,000,000 D Texas Employers Excess ECA3719729 12/01/2015 12/01/2016 Per Person Limit: 5,000,000 Indemnity SIR: $250,000 Per Occurrence Limit: 25,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins included as additional insured where required by written contract with respect to General Liability. General liability policy contains Additional Insured - Automatic -Owners, Lessees or Contractors U-GL-1175-F CW 04113. CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn. Jerri Groves THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason St, 2nd Floor ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherjee ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 103-185-392 LOC #: Minneapolis AC"R" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh USA Inc. NAMED INSURED G&K Services, Inc. and its Subsidiaries 5995 Opus Parkway, Suite 500 Minnetonka, MN 55343 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation (WI) Carrier: ACE Fire Underwriters Policy number: SCFC48597233 Policy dates: 12/01/2015 - 12/0112016 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD