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HomeMy WebLinkAbout131163 ADECCO - INSURANCE CERTIFICATE (4)® DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I12/29/2017 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 CONTACT Marsh USA. Inc. NAME: _- PHONE FAX 1166 Avenue of the Americas (A/C. No. Ext): — _ LAIC, No): New York, NY 10036 E-MAIL Attn: Adecco.certs@Marsh.com Fax. 212-948-0018 ADDRESS: _ INSURERS AFFORDING COVERAGE NAIC # 370044-ALL-ALL-18-19 NO INSURER A: AXA Insurance Company 33022 INSURED decco Inc. & its subsidiaries INSURER B : National Union Fire Insurance Co Of Pittsburgh 19445 10151 Deelwood 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 19380 INSURER E : American Home Assurance Company _ __ rucnaca c • 1lartfnrrl Pi- Incnran— Cnn— 19682 Cr1VFRArFS CFRTIFICATF NIIMRFR• NYC-009477490-15 RFVISIC)N NIIMRFR- 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(18) 01/0112018 01/01/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR DAMAGE TIRENTED 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 PRO - POLICY JECT [X] LOC X PRODUCTS -COMP/OP AGG $ 4,000,000 $ 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 OWNED AUTOS ONLY SCHEDULED AUTOS 7093434 (ADS) 01/01/2018 01/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LAB 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 ANYPROPRIETORlPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 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 F E&O / PROFESSIONAL LIABILITY 10 HH 0326579 18 01/01/2018 01/01/2019 EA. CLAIM/.AGG(SIR $500,000 $5M/$5M (INCLUDING NETWORK SECURITY) PRIVACY EVENT EXPENSE EA. CLAIMIAGG (SIR $250.00 $5M/$5M DESCRIPTION OF OPERATIONS / LOCATIONS / 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 r"CDTICIr`ATC Ur%l IICD CAAIrFI I ATIr)AI City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Ed Bonnette THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason St. ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins. CO 80524 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 370044 LOC #: New York ACOR�� 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: I IVIVHL RCIYIMMMO THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I 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: 01 /01 /2018 - 0111 /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: 04101/2017- 03/31/2018 LIMIT: $10,000,000 DEDUCTIBLE $1,000,000 AGUKU 101 (20O3101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD