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HomeMy WebLinkAbout131163 ADECCO - INSURANCE CERTIFICATE (5)Ago CERTIFICATE OF LIABILITY INSURANCE FD 2/292017DIYYYY) 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. ExO� IA/C, No): New York, NY 10036 E-MAIL Attn: Adecco.certs@Marsh.com Fax. 212-948-0018 ADDRESS: 370044-ALL-ALL-18-19 INSURED Adecco Inc & its subsidiaries 10151 Deerwood Park Blvd. Building 200, Suite 400 Jacksonville, FL 32256 NO c: INSURER E : American Co Of COVFRAGFR CFRTIFICATF NI IMRFR• NYr_MgA77Ao1.15 DDvlelnkl uu uaD11=D. I NAIC # 33022 19445 19429 23841 19380 19682 — 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) POCY EXP LI (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR PCS002071(18) 01/01/2018 01/01/2019 EACH OCCURRENCE $ 2,000,000 _ AMAGE TO RENTED PREMISES lEa occurrence $ 2,000,000 X MED EXP (Any one person) $ 5,000 CONTRACTUAL LIABILITY PERSONAL & ADV INJURY $ 2,000,000 GENT X AGGREGATE LIMIT APPLIES PER. POLICY IT]PEC LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OP AGG $ 4,000,000 $ OTHER B B AUTOMOBILE LIABILITY ANY AUTO 7093432 (MA) 7093433 (FL) 01/01/2018 01/01/2019 01/01/2019 01/01/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) _ $ B OWNED SCHEDULED AUTOS ONLY AUTOS 7093434 (AOS) 01/01/2018 01/01/2019 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ ROPERTY DAMAGE Per accident Zero X UMBRELLALIAB 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 RETENTION $ 10,000 $ D E C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under OF OPERATIONS below N / A 014122426 (AOS) 014122427(CA) 014122430 (FL) 01/01/2018 01101/2018 01/01/2019 01/01/2019 01I01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000DESCRIPTION $ 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. CLAIM/AGG (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, 4025 Automation Way F1, Fort Collins, CO 80525. VCR 1lrlliFl 1 C rIVLUCF( L;ANI.;tLLA I IVN City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attm Ed Bonnette THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason St. ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jason Clarke 3 © 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 ACORO® ADDITIONAL REMARKS SCHEDULE L 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_1 a] 9J I I Lei r_\ �:13PdJLi:1►7 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: 1/112018- 1/112019 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 014122433 STATE: MA, ND, WA, WI, WY POLICY PERIOD: 01101/2018 - 01/1/2019 PAPER: New Hampshire Insurance Company CARRIER: AIG POLICY NUMBER: 014122432 STATE:MN POLICY PERIOD: 01101/2018 - 01/0112019 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: 01101 /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: CRM1009415-02 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) U 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD