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HomeMy WebLinkAbout131163 ADDECO INC - INSURANCE CERTIFICATEi 1 ® ACOC>R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/21/2017 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 Marsh USA, Inc. 1166 Avenue of the Americas CONTACT NAME: PHONE FAX arc No E-MAIL ADDRESS: New York, NY 10036 Attn: Adecco.certs@Marsh.com Fax: 212-948-0018 INSURERS AFFORDING COVERAGE NAIC # INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-18-19 NO INSURED Adecco Inc. &its subsidiaries 10151 Deerwood Park Blvd. INSURER B : National Union Fire Insurance Co Of Pittsburgh 19445 INSURER C : Insurance Company of the State of Penns vania 19429 INSURER D : New Hampshire Insurance Company23841 Building 200, Suite 400 Jacksonville, FL 32256 INSURER E: American Home Assurance Company19380 INSURER F COVFRAGFS CERTIFICATE NUMBER: NYC-009494129-14 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. NOTVVITHSTANDING 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 M DIDY /YYYY M/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PCS002071(18) 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE FxI OCCUR DAMAGE TO RENT—E—D PREMISES Ea occurrence $ 2,000,000 X CONTRACTUAL LIABILITY MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY JE� Fx_1 LOC $ OTHER. B AUTOMOBILE LIABILITY X 7093432 (MA) 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BOD!L Y INJURY (Per person) $ B X ANY AUTO 7093433 (FL) 01/01/2018 01/01/2019 B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 7093434 (AOS) 01/01/2018 01/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X UMBRELLA LAB X OCCUR XS002072(18) 01/01/2018 01/01/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DIED I X RETENTION $10,000 $ D E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 014122426(ADS) 014122427 (CA) 014122430 FL ( ) 0110112018 0110112018 0110112019 0110112019 01/0112019 H X STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L DISEASE -EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below A E&O / PROFESSIONAL LIABILITY PCS002073(18) 01/01/2018 01101!2019 EA. CLAIWAGG(SIR $500,000 10,000,000 (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIWAGG (SIR $250,00 $5M/$15M DESCRIPTION OF OPERATIONS / 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. GERTIFIGATE HULUtK lrAIYIiCLLA I IVIN City of Fort Collins Attn: Ed. Bonnette 215 N. Mason St. Fort Collins, CO 80522 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 U 1913E-21,11b AL;UKU GUKYUKA I IUIV. An rignis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York A� VKLJ ADDITIONAL REMARKS SCHEDULE Page 2 of 2 111%�. AGENCY NAMED INSURED Marsh USA, Inc. Adecco Inc. & its subsidiaries 10151 Deerwood Park Blvd. POLICY NUMBER Building 200, Suite 400 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: 14122429 STATE: ME EFFECTIVE: 1/1/2018-1/1/2019 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 014122433 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 0110112018- 01/1/2019 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 014122432 STATE: MN POLICY PERIOD: 01/01/2018 - 01/01/2019 PAPER: New Hampshire Insurance Company CARRIER: AIG EXCESS WORKERS COMP-OHIO ONLY: INSURER: NATIONAL INSURANCE COMPANY OF THE STATE OF PA POLICY NUMBER: XWC 4595570 POLICY PERIOD: 01/01/2018- 01/01/2019 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: CRM1008415-02 CARRIER: ZURICH AMERICAN INSURANCE COMPANY POLICY PERIOD: 04/01/2017- 03/31/2018 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