HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc CERTIFICATE.OF,LIABIL �"
ACORO ITY INSURANCE
12/23/2011
,-THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND-CONFERS NO?RIGHTS UPON THE CERTI FICATE-HOLDER.-THIS.
"
CERTIFICATE.DOES..NOT, AFF.IRMATIVELY,:OR-NEGATIVELY:AM END; EXTEND OR ALTER THE COVERAGE AFFORDED.BY.THE POLICIES '
'BELOW 'THIS CERTIFICATE'OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ED
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 Phone No.: (212)488-0200 NAME:
Fax No.: (212)488-0220 PHONE
IAC,N>.Dat (Ar N*
Frankel&Company ADDRESS:
350 Hudson Street—4m Floor DR
New York, NY 10014
INSIIRERrSI AFFORgNC COVERAGE NAICY
INSURED INSURER A: Chards Specially Insurance Company 26883
POlydyne Inc. INSURER B: National Union Fire Insurance Company of Pittsburgh PA 19445
One Chemical Plant Road INSURERC: Hartford Fire Insurance Company of Midwest 37478
PO BOX 250 INSURER D: Commerce 8 Industry Insurance Company 19410
RiceboroGA 31323 NSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
..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•.TERMSr,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY BEENAEDUCED BY PAID CLAIMS. -
-� .� ADD. SUER. - - .. ,POLICY EFF . .POl1CYFXP.
tTR:'. .'.,TYPE aF WBURANLE ISR WVD - POLICYNUMBER _ ..
A- _E_ EG14362834 12/3112011 12/31/2012 EACH OCCURRENCE '$ 1,000,000
GENERAL LIABILITY y
r X 't. _ : DAMAGE TO RENTED
OMMERCIAL GENERAL LIABILITY PREMISES Ea ocwrrence '- - $ 500;000-'
CLAIMS MADE M OCCUR MED EXP(Any one person) $ 10,000
PERSONAL a ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 5,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
PR6 $
D AUTOMOBILE LIABILITY X CA4691818 12/31/2011 12/31/2012 COMBINED SINGLE LIMIT $ 1,000,000
(Ea armdenn
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS 'tl $
X NON-OWNED AUTOS - $
1
$
B X UMBRELAUAS X OCCUR X 25030662 12131/2011 12131/2012 EACH OCCURRENCE $ 1,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000
DEDUCTIBLE $
RETENTION S $
C WORKERS COMPENSATION 1OWNR30600 12/31/2011 12/3112012 U_X TORVTLIM TS ER
AND EMPLOYERS LIABILITY YIN V/N E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? E] WA
(MandYM,tr,MO E.L.DISEASE-FA EMPLOYEE $ 1,000,000
ry§aesn roe under
E.L.DISEASE-POLICY LIMIT $ 1,000,000
npqrRIPTIQN OF OPERATIONS Oshow
OESUPIION OF OPERATXxlS/LOCATIONS/VBKlES(AIbM ACDRD 101.AddtiorW Rm,aeb SclMrhde,rmxa apeu b,aglAed)
City of Ashland is included as Additional Insured under General Liability,Automobile Liability and ExcesslUmbrella Liability Coverage as required by Contract with respect to
liability arising out of the operations of the Named Insured,as their interest may appear,and subject to the policy terms Conditions and exclusions.Coverage applies on a primary
and noncontributory basis as required by contract and subject to the policy tens Conditions and exclusions.
RE:Polymer—Clarifloc C-6286
45 DAY CANCELLATION CLAUSE INCLUDED
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 N.Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS
Ashland,OR 97420
ALT RIM REPRESENTAT 1
1 2009 CORD CORPORATION.All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are re stared marks of ACORD