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HomeMy WebLinkAbout112967 G & K SERVICES INC - INSURANCE CERTIFICATE (4)The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 2 2 For Texas workers’ compensation, note Texas Employers Excess Indemnity policy.� � Minneapolis Carrier: ACE Fire Underwriters� Workers Compensation (WI)� Policy dates: 12/01/2015 - 12/01/2016� Policy number: SCFC48597233� �� �� � Workers Compensation Cont:� Certificate of Liability Insurance 103-185-392 �� Marsh USA Inc.� 5995 Opus Parkway, Suite 500� G&K Services, Inc. and its Subsidiaries� Minnetonka, MN 55343 25 PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. B 1,000,000 HDOG27402744 Manashi Mukherjee WLRC48597191 (AZ, CA, MA) 15,000,000 CHI-006430381-04 1,000,000 5,000,000 ND, OH, WA & WY) X X 25674 5,000,000 SIR: $250,000 Per Occurrence Limit: of Marsh USA Inc. Attn: Minneapolis.CertRequest@marsh.com Fax 212-948-0114 N X 2,000,000 12/01/2015 7 12/01/2016 12/01/2015 37532 12/01/2016 ISAH08866387 Texas Employers Excess C 2,000,000 1,000,000 Workers Comp is not provided in TX 43575 Travelers Property Casualty Company of America 1,000,000 X D X 11/02/2016 008 25,000,000 12/01/2015 5,000,000 12/01/2015 Re: Location Name - Denver Policy General Aggregate X POLICY GENERAL AGG 215 N. Mason St, 2nd Floor Fort Collins, CO 80522 City of Fort Collins Great American E&S Insurance Company 10,000 City of Fort Collins included as additional insured where required by written contract with respect to General Liability. A A Indemnity Insurance Company of North America Per Person Limit: 10,000 12/01/2016 3,000,000 ZUP11T7047815NF Indemnity 22667 1,000,000 1,000,000 12/01/2016 WLRC48597154 (AOS) (incl Stop Gap 333 South 7th Street, Suite 1400 Marsh USA Inc. X Minneapolis, MN 55402-2400 5995 Opus Parkway, Suite 500 G&K Services, Inc. and its Subsidiaries Minnetonka, MN 55343 X X ECA3719729 12/01/2015 Attn: Jerri Groves 12/01/2015 A 12/01/2016 12/01/2016 ACE American Insurance Company