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HomeMy WebLinkAbout131163 ADECCO INC - INSURANCE CERTIFICATE (8)CERTIFICATE OF LIABILITY INSURANCE DATE (/2016 YYYY) 12I202016 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 NAME: Marsh USA, Inc. PHONE IFAX 1166 Avenue of the Americas __- A/c No): E-MAIL New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-17-18 NO INSURED INSURER B: National Union Fire Insurance Co Of Plftsburjh 19445 Adecco Inc. & its subsidiaries INSURER C : Insurance Company of the State of Pennsylvania 19429 10151 Deerwood Park Blvd, INSURER D : New Hampshire Insurance Company 23841 Building 200, Suite 400 Jacksonville, FL 32256 INSURER E: American Home Assurance Company 19380 INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-007292558-11 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY 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 � OCCUR DAMAGE S RENTED PREMISE PREMIS 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 X POLICY JE O LOC PRODUCTS -COMP/OP AGG $ 4,000,000 $ OTHER d AUTOMOBILE LIABILITY 1921832 (MA) O1/0112017 01/01/2018 Ea COMBINED SINGLE LIMIT a ccident $ 2,000,000 X BODILY INJURY (Per person) $ B ANY AUTO 1921833 (FL) 01/01/2017 01/01/2018 B ALL OWNED SCHEDULED AUTOS AUTOS 1921834 (NY) 01/01/2017 01/01/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR XS002072(17) 01/01/2017 01/01/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $10 000 $ D E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 14649688 (AOS) 14649694 (CA) t4649690 (FL) 01/01/2017 01/01/2017 0110112017 01/01/2018 01/01/2018 01/01/2018 X PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 2,000,000DESCRIPTION $ A E&0 / PROFESSIONAL LIABILITY PCS002073(17) 01/01/2017 01/01/2018 EA. CLAIMIAGG(SIR $500,000) $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIMIAGG (SIR $250,000) $5M/$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. CERTIFICATE HOLDER 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 AGENCY CUSTOMER ID: 370044 LOC #: New York ACC>R" ADDITIONAL REMARKS SCHEDULE r� 1 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: 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: 1l1/2017- 11112018 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 14649691 STATE: MA, ND. WA, WI, WY POLICY PERIOD: 01101/2017 - 0111/2018 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 14649692 STATE: MN POLICY PERIOD: 0110112017 - 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- 03/31 /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