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HomeMy WebLinkAbout131163 ADECCO INC - INSURANCE CERTIFICATE (11)ACOR 1 a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYYYY) 12/19/2017 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 A/c No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 New York, NY 10036 Attn: Adecco.certs@Malsh.com Fax: 212-948-0018 INSURER A: AXA Insurance Company 33022 370044-ALL-ALL-18-19 NO INSURED decco 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 Pennsylvania _ 19429 _ INSURER D : New Hampshire Insurance Company 23M1 Building 200, Suite 400 Jacksonville, FL 32256 INSURER E :American Home Assurance Company19380 INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-009477490-13 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 MM DPOLI CY EFF D/YYYY POLICY EXP M/DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 'PCS002071(18) 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE rx] OCCUR DAMAGE TO RENTED 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 PE� LOC $ OTHER: B AUTOMOBILE LIABILITY -7093432 (MA) 01/01/2018 01/01/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ B X ANY AUTO -7093433 (FL) 01/01/2018 01/01/2019 B oU E ONLY SCHEDULED AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY -7093434 (ADS) 01/01/2018 01/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR 'XS002072(18) 01/01/2018 01/01/2019 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 Y / N OFF C RPM EMBEREXCLUDED? ECUTIVE N (Mandatory in NH) ❑ N/A -014122426 (AOS) '014122427 (CA) '014122430 (FL) 01/01/2018 01/01/2018 01/01/2019 01/0112019 01/01/2019 X STATUTE ERH — E.LEACH 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) 01/0112018 01101/2019 EA. CLAIMIAGG(SIR $500,000 $51VI$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIMIAGG (SIR $250,00 $5MI$5M 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, City of Fort Collins Attn: Ed Bonnette 215 N. Mason St. Fort Collins, CO 80524 ■L-JIJ 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 19U5-2U1b AGUKU GUKNUKA I IUN. Ali rlgnrs reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD �CORO® AGENCY CUSTOMER ID: 370044 LOC #: New York ennirintiA1 OPRAA WQ elrrul=nl i1 C 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: DDITIONAL REMARKS ITHIS 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/l/2018-1/l/2019 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 014122433 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01/01/2018 - 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 LL;UKU 1U1 (ZUUtS1U1) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD