HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific (2)
® CERTIFICATE OF LIABILITY INSURANCE °ATEWwOD"YY"'
1211412012
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:
FAX
1717 Arch Street PHONE A/C Not:
Philadelphia, PA 19103-2797 E-MAIL
Attn: PHILADELPHIA.CERTS@MARSH.COM/FAX-212.948-0360 - ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC a
424780-'ALL-GAW-13-14 INSURER A: Insurance Company Of The State Of PA 19429
INSURED BRENNTAG PACIFIC INSURER e : Greenwich Insurance Company 22322
10747 PT , INC.
10747 ATTERSON PLACE INSURER C : XL Specialty Insurance Company 37885
SANTA FE SPRINGS, CA 90670 INSURER D:
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: CLE-003286428-16 REVISION NUMBER:3
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 TYPE OF INSURANCE 1=ADDL SUER POLICY EFF
LTR POLICY NUMBER aWpD/YYYY MM! POLICY EXP LIMITS
A GENERAL LIABILITY 0695955 0110112013 0110112014 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea unence $ 1'000'000
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10.000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS'-COMP/OP AGG $ 1,000,000
X POLICY PRO- LOC $
JECT B AUTOMOBILE LIABILITY RAD943713308(ADS) 01101/2013 0110112014 COMBINED SINGLE LIMIT 1,000,000
Ea accident
B X ANY AUTO RAD943713108 (MA) 01101/2013 0110112014 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
$
HIRED AUTOS AUTOS Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE I AGGREGATE $
DED RETEMION$ $
WORKERS COMPENSATION X WC STATU- OT H-
AND EMPLOYERS' LIABILITY
C ANY PROPRIETOR/PARTNEWEXECUTIVE YIN RWR943509008(WI) 0110112013 0110112014 1,000,000
OFFICERIMEMBER EXCWOE01 E.L. EACH ACCIDENT $
C (Mandatory in NH) N N/A RWD943509108(ADS) 01101/2013 0110112014 E.L. DISEASE-EA EMPLOYE $ 1,000.000
If yes, dewibe under 1 0001300
DESCRIPTION OF OPERATIONS oarow E.L. DISEASE POLICY LIMIT $
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: SUPPLYING CHEMICALS TO THE WATER TREATMENT PLANT LOCATED AT: 90 N. MOUNTAIN AVENUE, ASHLAND, OR 97520
THE CITY OF ASHLAND. OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION, WHERE
REQUIRED BY WRITTEN CONTRACT.
00 DER
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND, OR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN: KARI OLSON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 NORTH MOUNTAIN AVENUE ACCORDANCE WITH THE POLICY PROVISIONS.
ASHLAND, OR 97520
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manasht Mukherjee ~t~LUraot.,:
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
0008090 SP 0413 -001-P08094-1
CITY OF ASHLAND, OR
ATTN: KART OLSON
90 NORTH MOUNTAIN AVENUE
ASHLAND, OR 97520
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