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HomeMy WebLinkAboutPEOPLEREADY INC - INSURANCE CERTIFICATE (4)AGORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/1/2019 6/25/2018 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 have ADDITIONAL INSURED provisions or 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 CONTCT NAME; PHONE A A/C No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC n (303) 414-6000 INSURER A: National Union Fire Ins Co Pitts. PA 19445 INSURED PeopleReady, Inc. 1036748 1015 A. Street PO Box 2910 INSURER B : New Hampshire Insurance Company 23841 INSURER C : Insurance Company of the State of PA 19429 INSURER : American Home Assurance Company 19380 Tacoma, WA 98401 INSURER E : 48837-1999 INSURER F : COVERAGES CERTIFICATE NUMBER: 13028266 REVISION NUMBER: 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 SUER WV[) POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 4786805 7/1/2018 7/1/2019 EACH OCCURRENCE 1,000,000 CLAIMS -MADE OCCUR }( DAMAGE TO RENTED PREMISES Ea occurrence I OOO OOO X MED EXP (Any oneperson) XXXXXXX SIR SI M PERSONAL & ADV INJURY $ 1000 000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 5,000,000 X POLICY❑ PRO-❑ LOC PRODUCTS - COMP/OP AGG $ 3,000,000 1 $ OTHER A AUTOMOBILE LIABILITY Y N 7742318 (AOS) 7/1/2018 7/l/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 A A ANY AUTO 7742320 (MA) 7742319(VA) 7/1/2018 7/l/2018 7/1/2019 7/1/2019 X BODILY INJURY (Per person) $ XXXXXXX BODILYINJURY(Peraccident $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE $ XXXXXXX AUTOS ONLY AUUTOS ONLDY $XXXXXXX A X UMBRELLA LIAB X OCCUR N N 28294901 7/I/2018 7/l/2019 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N 14590719, 18177132, 18177128 7/1/2018 7/1/2019 PER OTH- X STATUTE ER D ECUTIVE N❑ N / A 14590725, 18177130 14590721 7/1/2018 7/1/2018 7/11/2019 7/1/2019 eL EACH ACCIDENT $ 1,000,000 OFFICER/MEM ER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 A Excess Work Comp N N 4595602-QSI 7/I/2018 7/1/2019 SIR $350,000 each accident DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 'I he above coverages apply only to temporary employees dispatched to do work on behalf of the Named Insured. City of Fort Collins is named as Additional Insured if required by written contract between Labor Ready and City of Port Collins as respects General and Auto Liability. CERTIFICATE HOLDER CANCELLATION See Attachments 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 ll f1� l ACORD 25 (2016103) ©1 8 2015 ACORD CORPO TIC) All rights reserved The ACORD name and logo are registered marks of ACORD