HomeMy WebLinkAbout552492 ANYTIME LABOR DBA LABORMAX STAFFING - INSURANCE CERTIFICATE (2)ACOR"@ CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
�3/1/2019
2/23/2017
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
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
CONTACT
NAME:
HONE FAX
A/C, No, Ext : A/C, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Everest National Insurance Company
1 01 20
INSURED ANYTIME LABOR - COLORADO LLC
1349554 dba: LaborMAX Staffing
971 PREMIER DRIVE
INSURER B : XL Specialty Insurance Com anv
37885
INSURER C :
INSURER D :
KEARNEY MO 64060
INSURER E :
INSURER F :
COVERAGES ANYLA01 CERTIFICATE NUMBER_ 1341 3831 REVISION Nt1MRFR• 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
91ML000142-181
3/1/2018
3/1!2019
EACH OCCURRENCE
1.000,000
CLAIMS -MADE OCCUR
PREMISES (Ea RENTED
1,000 000
MED EXP (Any oneperson)
10,000
PERSONAL & ADV INJURY
$ 1,000,000
TEN-1- AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER.
A
AUTOMOBILE
LIABILITY
Y
N
91 ML000142-181
3/1/2018
3/1/2019
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$ XXXXXXX
ANY AUTO
AUTOS ONLY AUTOS
I
BODILY BODILY INJURY (Per accident
$ XXXXXXX
HIRED NON-WD
AUTOS ONLY X AUUTOS ONLYY
X
ERT
P �a c,d y,,,) GE
$ XXXXXXX
$XXXXXXX
A
X
UMBRELLA LIAB
X
OCCUR
N
N
91CU000143-181
3/1/2018
3/l/2019
EACH OCCURRENCE
$ 51000,000
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$ XXXXXXX
1
1
B
ANDEMPLOYERS' LABILI Y Y/N
N
RWD3000731-03
3/1/2018
3/1/2019
X STATUTE I HER
E.L. EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?FN
NIA A
E.L. DISEASE - EA EMPLOYEE
1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
E.L. DISEASE - POLICY LIMIT
1,000,000
A
CRIME (EMPLOYEE
DISHONESTY TNCL.
N
N
-181
3/1/2018
3/1/2019
11,000,000 PER OCC
$10,000 DED
THIRD PARTY THEFT
11ICR10101
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CITY OF FORT COLLINS IS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY AND AUTO LIABILITY
COVERAGES, ONLY AS REQUIRED BY CONTRACT, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY.
v 1... 1 1 1IV LVLI\ 6rM1\IrGLLM I IVI\
13413831
City of Fort Collins
Traffic Operations
626 Linden Street
Fort Collins CO 80524
ACORD 25 (2016/031
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
,t' A,,01�1 wi
n1 R-2015 ACORD CORPORATION_ All rinhts rPSPrvPcI
The ACORD name and logo are registered marks of ACORD