HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific
Acoa CERTIFICATE OF LIABILITY INSURANCE 1DATL1E 4 (12012 YYYY)
2012
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 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:
1717 Arch Street PHONE AIC Nc :
Philadelphia. PA 191032797 E-MAIL
Ann: PHILADELPHIA. CERTSCwMARSH.COA4IFAX-212-948-0360 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC If
424780-'ALL-GAW-13-14 INSURER A: Insurance Company Of The Slate Of PA 19429
INSURED INSURER B : Greenwich Insurance Company 22322
BRENNTAG PACIFIC, INC.
10747 PATTERSON PLACE INSURER C: XL Specialty Insurance Company 37805
SANTA FE SPRINGS, CA 90670 INSURER D:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: CLF-003286527-19 REVISION NUMBER:4
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 ADDLUBR POLICY EFF POLICY EXP
TYPEOFINSURANCE POLICY NUMBER MWDDIVYYY MWOD
L MIYY LIMITS LIPS A GENERAL LIABILITY 0696955 01101/2013 0110112014 EACH OCCURRENCE $ 1,000.000
DAMAGE T RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence) $ 1,000,000
CLAIMS-MADE M OCCUR MED EXP (An one person) $ 10.000
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP ADD $ 1.000.000
[ "CT PRO- LOC $
X POLICY
B AUTOMOBILE LIABILITY RAD943713308 (ADS) 0110112013 0110112014 COMBINED SINGLE LIMIT 1 .000,000
_IEa accXientl
B % ANY AUTO RAD94 3 71 3108 (MA) 0110112013 0110112014 BODILY INJURY (Per Person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Pera¢itlen0 $
NON-OWNED PROPERTY DAMAGE
$
HIRED AUTOS AUTOS Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION X WC STATU OTH-
AND EMPLOYERS' LIABILITY
C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N RWR943509008 (WI) 0110112013 0110112014 E.L. EACH ACCIDENT $ 1'000'000
OFFICER/MEMBER in NMI REXCLUOED7 NIA
C RWD943509108 (ADS) 0110112013 0110112014 E. DISEASE - EA EMPLOYE $ 1,000,000
O
If yes, describe under 1,000000
DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A11achACORD101,Mdidor Namarha Sc uW,Itmoreapaceifrequire0)
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1195 OAK STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee _Mauao4 Qp4~e,r_
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD