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HomeMy WebLinkAbout131163 ADECCO INC - INSURANCE CERTIFICATE (7)AoCa CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYYYY) 12/20/2016 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 CONTACT Marsh USA, Inc. NAME: PHONE FAX 1166 Avenue of the Americas _tAlc, No FExtk--_ __ - ___ _ _ _ _ _ ___ _ _ A/c No): New York, NY 10036 E-MAIL Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 ADDRESS: _ INSURERISI AFFORDING COVERAGE NAIC # 370044-ALL-ALL-17-18 _ NO _ INSURER A: AXA Insurance Company 33022 INSURED Adecco Inc. &its subsidiaries INSURER B : National Union Fire Insurance Co Of Pittsburgh 19445 10151 Deerwood Park Blvd. INSURER c : Insurance Company of the State of Pennsylvania 19429 Building 200, Suite 400 INSURER D : New Hampshire Insurance Company 23841 Jacksonville, FL 32256 INSURER E: American Home Assurance Company 19380 INSURER F : CnVFRAGFS CFRTIFICATF Nl1MBER- NYC-007292557-11 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 1HI L WVDSUBR POLICY NUMBER POLICY EFF MM/DDYYYY POLICY EXP MM /DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PCS002071(17) 01/01/2017 01/01/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X_ OCCUR 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 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECOT- LJ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER E AUTOMOBiLE LIABILITY 192 i332 (MA) 01/01/2017 01/01/2018 CEa OMBINED SINGLE- LIMITaccident $ 2,000,000 BODILY INJURY (Per person) $ B X ANY AUTO 1921833 (FL) 01/01/2017 01/01/2018 BODILY INJURY (Per accident) $ B ALL OWNED SCHEDULED AUTOS AUTOS 1921834 (NY) 01/01/2017 01101/2018 PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS A X UMBRELLA LAB X OCCUR XS002072(17) 01/01/2017 01/01/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE_ $ 5,000,000 EXCESS LIAR CLAIMS -MADE DIED I X I RETENTION $10,000 $ D E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED' (Mandatory in NH) N/A 14649688(AOS) 14649694 (CA) 14649690 (FL) 01/01/2017 01101/2017 01/01/2017 01/01/2018 01I0112018 01/01/2018 X PER I OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2.000,000 A E&O / PROFESSIONAL LIABILITY PCS002073(17) 11/01/2017 01/01/2018 EA. CLAIMIAGG(SIR $500,000) $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIMIAGG (SIR $250,000) $5MI$5M DESCRIPTION OF OPERATIONS / 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. City of Fort Collins Attn: Ed Bonnette 215 N. Mason St. Fort Collins, CO 80524 MANE,.-LLA I IVIV 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 � cam, _ �• © 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 A 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: 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: 14649693 STATE:ME EFFECTIVE: 111/2017- 1/112018 PAPER. New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 14649691 STATE: MA, NO, WA, WI, WY POLICY PERIOD: 01/01/2017 - 01/1/2018 PAPER: New Hampshire Insurance Company CARRIER AIG POLICY NUMBER: 14649692 STATE: MN POLICY PERIOD: 01/01/2017 - 01/01/2018 PAPER: New Hampshire Insurance Company CARRIER: AIG EXCESS WORKERS COMP-OHIO ONLY: INSURER. NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: 6583133 POLICY PERIOD: 01/01/2017 - 01 /01 /2018 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- 03131/2017 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