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HomeMy WebLinkAbout131163 ADECCO INC & ITS SUBSIDIARIES - INSURANCE CERTIFICATE (8),464 i CERTIFICATE OF LIABILITY INSURANCE DATE /2016 /YYYY) 04104/2016 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 CONTACT NAME: _ A/C- No. EMjL_ ONE FAX No): _ ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-16-17 NO INSURED Adecco Inc. & its subsidiaries INSURER e : National Union Fire Insurance Co Of Pittsburgh 19445 INSURER C : Insurance Company of the State of Pennsylvania 19429 10151 Deerwood Park Blvd. Building 200, Suite 400 Jacksonville, FL 32256 INSURER D : - - INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-007282597-09 REVISION NHMRFR-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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PCS002071(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 X MED EXP (Any one person) $ 5,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 2,000,000 GEN'L XL NJJECT AGGREGATE LIMIT APPLIES PER: PRO - POLICY X 1 [�] LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER B B AUTOMOBILE LIABILITY ANY AUTO X 9734263 (MA) 9734264 (FL) 01/01/2016 01/01/2016 01/01/2017 01/01/2017 COEa aMBINED SINGLE LIMITccident $ 2,000,000 X BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS 9734265 (AOS) 01/01/2016 01/01/2017 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X IOCCUR XS002072(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAR CLAIMS MADE DIED I X RETENTION $10 000 $ C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE a OFFICER/MEMBER EXCLUDE D9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 066830117(AOS) 066830118 (CA) 066830119 (FL) 01/01/2016 O1/Ot/2016 01/01/2016 01/01/2017 01/01/2017 01/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 A E&O / PROFESSIONAL LIABILITY PCS002073(16) 01/01/2016 01/01/2017 EA. CLAIM/AGG(SIR $500,000) 10,000,000 (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIWAGG (SIR $250,000) $5M/$15M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins CO 80525. IrGR I IrIVA 1 C r7VLLlCrN tANL:tI_L.A I IUN 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York �°►� ��r�-' ADDITIONAL KtMAKK5 bUNr-uuLt rayC t AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. POLICY NUMBER Building 200, Suite 400 Jacksonville, FL 32256 CARRIER --tNAIL 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 COMP CONTINUED: POLICY NUMBER: 066830120 STATE:ME POLICY PERIOD: 0110112016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830122 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01/0112016- 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830121 STATE: MN POLICY PERIOD: 01/01/2016 - 01/01/2017 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: XWC 2203536 POLICY PERIOD: 01/0112016 - 01/01/2017 LIMITS. SIR:$3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM1008415-01 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 04I01/2016- 03/01/2017 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 4CORD 101 (2008/01) V [UU6 AL UKLJ Cvrtr0mA i Iv1Y. rau nynw Cacvcu. The ACORD name and logo are registered marks of ACORD ' 1 ® A` 0R" CERTIFICATE OF LIABILITY INSURANCE F7�TJE (MM/DDlYYYY) 04/2016 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 CONTACT NAME:__ PHONE FAX _ AIc No), E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # _ INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-16-17 NO INSURED Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. INSURER B: National Union Fire Insurance Co Of Pittsburgh 19445 iNSURER C : Insurance Company of the State of Pennsylvania 19429 INSURER D : Building 200, Suite 400 Jacksonville, FL 32256 INSURER E INSURER F : rnv11=0An0C 17POTIGIrt-ATE NUMBER- NYC-007292559-09 REVISION NUMBER: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 I LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PCS002071(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 2,000,000 IT]OCCUR _7CLAIMS-MADE DAMAGE 0 1111E� nce PREM SESOE. ..... $ 2,000,000 X MED EXP (Any one person) $ 5,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OP AGG $ 4,000,000 X POLICY a JE 0 � LOC OTHER: B AUTOMOBILE LIABILITY 9734263 (MA) 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident $ 2,0007000 BODILY INJURY (Per person) $ B X ANY AUTO 9734264 (FL) 01/01/2016 01/01/2017 BODILY INJURY (Per accident) $ B ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 9734265 (AOS) 01/01/2016 01/01/2017 PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR XS002072(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION $10 000 $ C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A 066830117 (AOS) 066830118 (CA) 066830119 FL ( ) 01/01/2016 01/01/2016 01/01/2016 01/01/2017 01/01/2017 01/01/2017 X STATUTE OERH 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 / PROFESSIONAL LIABILITY PCS002073(16) 01/01/2016 01/01/2017 EA. CLAIMIAGG(SIR $500,000) $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIMIAGG (SIR $250,000) $5M1$5M DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Branch Location: Adecco Engineering & Technical, 4025 Automation Way F1, Fort Collins, CO 80525, City of Fort Collins Ann: Ed Bonnette 215 N. Mason St. Fort Collins, CO 80522 %1MIYIi CL -M 1 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 (9) 198E-ZU14 AUUKU UUKVUKA I IUN. Alt rlgnts reservea. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York ACOR" Imo_ — ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. Building 200, Suite 400 POLICY NUMBER Jacksonville, FL 32256 CARRIER NAIC CODE EFFECTIVE DATE: ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: POLICY NUMBER: 066830120 STATE:ME POLICY PERIOD: 01/01/2016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830122 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01/01/2016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830121 STATE:MN POLICY PERIOD: 01/01/2016 - 01/01/2017 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: XWC 2203536 POLICY PERIOD: 01/01/2016- 01/01/2017 LIMITS: SIR:$3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM1008415-01 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 04/01/2016- 03/01/2017 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 AGUKU 1U1 (ZU1UtS/1U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORU0 C" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 04/04/2016 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 Marsh USA, Inc. 1166 Avenue of the Americas CONTACT NAME: FAX PHONNo Ex A/C No): E-MAIL ADDRESS: New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-16-17 NO INSURED Adecco Inc. & its subsidiaries INSURER B : National Union Fire Insurance Co Of Pittsburgh 19445 INSURER C : Insurance Company of the State of Pennsylvania 19429 10151 Deerwood Park Blvd. INSURER D Building 200, Suite 400 Jacksonville, FL 32256 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-007292558-09 REVISION NUMBER: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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PCS002071(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE a OCCUR DAMAGES ( RENTED PREMISES Ea occurrence $ 2,000,000 X MED EXP (Any one person) $ 5,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 POLICY [X]JECT a LOC X PRODUCTS -COMP/OP AGG $ 4,000,000 $ OTHER. B AUTOMOBILE LIABILITY 9734263 (MA) 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ B ANY AUTO 9734264 (FL) 01/01/2016 01/01/2017 B ALL OWNED SCHEDULED AUTOS AUTOS 9734265 (AOS) 01/01/2016 01/01/2017 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR XS002072(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $10 000 $ C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 066830117 (AOS) 066830118 (CA) 066830119 FL ( ) 01/01/2016 01/01/2016 01/01/2016 01/01/2017 01/01/2017 01/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYE Id $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 A E&O / PROFESSIONAL LIABILITY PCS002073(16) 01/01/2016 01/01/2017 EA. CLAIMIAGG(SIR $500,000) $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIWAGG (SIR $250,000) $5W$5M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Branch Location: Adecco Engineering & Technical, 300 E. Boardwalk, Fort Collins, CO 80525. UtK I IrIUA 1 t HULUtK 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACOREP AGENCY CUSTOMER ID: 370044 LOC #: New York ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. POLICY NUMBER Building 200, Suite 400 Jacksonville, FL 32256 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 COMP CONTINUED: POLICY NUMBER: 066830120 STATE:ME POLICY PERIOD: 01/01/2016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830122 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01/0112016 - 011112017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830121 STATE:MN POLICY PERIOD: 01/01/2016 - 01/0112017 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: XWC 2203536 POLICY PERIOD: 01/01/2016 - 01/01/2017 LIMITS: SIR:$3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM1008415-01 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 0410112016- 03/01/2017 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 Page 2 of 2 ACORD 101 (2008/01) lJ cvvo r+wRv �+vr.wr�.+�+•.• r••• ••y••w •• ��• •� The ACORD name and logo are registered marks of ACORD 7 ® A,iC400RD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/04/2016 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 CONTACT NAME: PHONE FAX (A/C. No.xt : A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-16-17 NO _ INSURED Adecco Inc. & its subsidiaries 10151 Deetwood Park Blvd. INSURER B : National Union Fire Insurance Co Of Pittsburgh 19445 INSURER C: Insurance Company of the State of Pennsylvania 19429 INSURER D : Building 200, Suite 400 Jacksonville, FL 32256 INSURER E INSURER F : ...,..— ^=O rGoTlr:irATG kl IUBER• NYC-007292557-09 REVISION NUMBER:! vvv-- --- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDING 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 INSURANCEINSD ADDL SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PCS002071(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED $ 2,000,000 CLAIMS -MADE � OCCUR PREMISES Ea occurrence X CONTRACTUAL LIABILITY MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OP AGG $ 4,000,000 X POLICY a � LOC JECT OTHER B AUTOMOBILE LIABILITY 9734263 (MA) 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ B X 9734264 (FL) 01/01/2016 01/01/2017 ANY AUTO BODILY INJURY (Per accident) $ B ALL OWNED SCHEDULED 9734265 (AOS) 01/01/2016 01/01/2017 AUTOS AUTOS NON -OWNED PROPERTY DAMAGE Per accident $ HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR XS002072(16) 01/01/2016 01/01/2017 EACH OCCURRENCE $ 5,000,000 I AGGREGATE $ 5,000,000 EXCESS LIAB I CLAIMS -MADE DED I X I RETENTION $1O 000 $ C WORKERS COMPENSATION 066830117 (AOS) 01/01/2016 01/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� 066830118 (CA) Ot/01/2016 01101/2017 E L DISEASE - EA EMPLOYEE $ 2,000,000 C (Mandatory in H) EXCLUDED? (Mandatory in NH) N / A 066830119 (FL) 01/01/2016 01/01/2017 E.L. DISEASE - POLICY LIMIT - $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A E&O / PROFESSIONAL LIABILITY PCS002073(16) 01/01/2016 01/01/2017 EA. CLAIM/AGG(SIR $500,000) $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIWAGG (SIR $250,000) $5M/$5M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Branch Location: Adecco Staffing, 3711 JFK Parkway, Suite 305, Fort Collins, CO 80525. CERTIFICATE HOLDEK r rvr` 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 _J4f --1 V l`JiSif-LUl4 Ht+V KU liVRrvrtArry rv. rur nynw rcacrvcu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York AC"REP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. Building 200, Suite 400 POLICY NUMBER Jacksonville, FL 32256 CARRIER NAIC CODE EFFECTIVE DATE: ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMP CONTINUED: POLICY NUMBER: 066830120 STATE: ME POLICY PERIOD: 01/01/2016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830122 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01/01/2016 - 01/1/2017 PAPER: INSURANCE COMPANY OF THE STATE OF PA CARRIER: AIG POLICY NUMBER: 066830121 STATE:MN POLICY PERIOD: 01/01/2016 - 01/01/2017 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: XWC 2203536 POLICY PERIOD: 01/01/2016- 01/01/2017 LIMITS: SIR: $3,000,000 EL EACH ACCIDENT: $1,000,000 EL DISEASE: $1,000,000 EL DISEASE - EACH EMPLOYEE: $1,000,000 CRIME: WITH THIRD PARTY COVERAGE POLICY NUMBER: CRM1008415-01 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 04/01/2016- 03/01/2017 LIMIT: $10,000,000 DEDUCTIBLE: $1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD