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Home My WebLink AboutInsurance Certificate: Univar USA Inc I DATE(MMIDDI9Y)"Y) ~►v ° CERTIFICATE OF LIABILITY INSURANCE 0226I2013 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 C AOn Risk services central, Inc. NAMEPHONE PA Office (NC.N.E,d): (866) 283-7122 NP : (847) 953-5390 v one Liberty Place E# I_ 1650 Market Street ADDRESS: _ suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE HAICR INSURED INSURER& National union Fire Ins Co of Pittsburgh 19445 UNIVAR USA INC INSURER B: Insurance CO of the State of PA 19429 17425 NE Union Hill Road Redmond WA 98052-3375 USA INSURER C: Illinois National Insurance Co 23817 INSURER D: INSURER ED,' INSURER F: COVERAGES CERTIFICATE NUMBER: 570049136166 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested WSR ADIX SUER POLICY E.1 LTR TYPE OF INSURANCE INSR MO POLICY NUMBER 'MIDRYYYVI MWDDfYY(Y) LIMITS A GENERAL LIABILITY 2802979 U31011ZUIJ 03/01/2014 EACH OCCURRENCE $3,000,000 % COMMERCIAL GENERAL LIABILITY SIR applies per policy terns & COndl IOnS $300, 008 PREMISES Ea..nce CLAIMS-MADE X❑OCCUR MED E%P(My.. prawn) EXCluded SIR: $2,ODD,DDD PERSONAL S ADV INJURY X $3,000,000 GENERAL AGGREGATE $3,000,000 m GENI. AGGREGATE UMM APPLIES PER PRODUCTS - COMPIOP AGO $3,000,000 m JET F O X POLICY PRO- - LOG n A AUTOMOBILE LIABIL" 4806890 121303/01/2014 COMBINED SINGLE LIMIT $5,000,000 Truckers Liability (ADS) a mean A X ANY AUTO 4806891 03/01/2013 03/01/2014 BODILY IWURY(PM prawn) o ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURV(Perarntlent) O A Avrps Auros 4806892 03/01/2013 03/01/20141 ' HIRED AUTOS PROPERTY DAMAGE R AUT 9WNED Truckers Liability (VA) Per ecd4enl I~ C 0 UMBRELLA LIAB OCCUR EACH OCCURRENCE t.7 EXCESS LIAR CLAIMS-MADE AGGREGATE OED RETENTION B WORKERS COMPENSATION AND 001591220 03/01/2013 03/01/2014 X WL STATLL OTH- ENPLOYERWI-JABILITY YIN AOS TORY LIMBS ANY PROPRIEfORIPARTNERIEXECUINE EL EACH ACCIDENT $1,000,000 A OFFICEWMEMBER EXCLUDED] NIA 1591222 03/01/2013 03/01/2014 (MaMnory In NH) CA, OH, OR & WA E.L. DISEASE-EA EDPLOYEE 51,000,000 rcy °"tri° uMer SIR applies er ter s & condi ions nESLRIPTONOFOPERATIO.sU P policy E.L.DISEASEFOLIC/LIMn $1,000,000_ _TFT DESCRIPTION OF OPEMTONS I LOCATIONS I VEHICLES (ABace ACORD 1D1, MEa l Remarks Sc uW. K more sP+ Ir required) RE: Bid #2008-101 & Bid 2008-102, superfloc N-300 LMW; Calcium Hypochlorite; Caustic Soda; Sodium Hypochlorite; SBS; Location: Portland. City of Ashland and all employees are included as Additional insured on the General Liability and Automobile Liability Policies with respect to written contract. univar is self-insured for physical damage to their vehicles. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESEWArnflE Attn: Kari Olson _ 90 N. Mountain Avenue Ashland OR 97520 USA W o r7 c~'oss 01966-2r01100 ACORD CO(RPO~nRATIO`N., Ail rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC Page _ of _ ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED ADD Risk services central, Inc. UNIVAR USA INC POLICY NUMBER see certificate Number: 570049136166 CARRIER NAIC CODE See Certificate Number: 570049136166 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER - ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY ]NSA ADDL SUBR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSR wVD POLICYNUMBER LIMITS DATE DATE MMIDD MM/DD/YYV AUTOMOBILE LIABILITY A 4806893 03/01/2013 03/01/2014 Combined 8510001000 Commercial Auto (ADS) Single Limi A 4806894 03/01/2013 03/01/2014 Commercial Auto (MA) A 4806895 03/01/2013 03/01/2014 Commercial Auto (VA) WORKERS COMPENSATION C N/A 001591223 03/01/2013 03/01/2014 MA, NO, WI, WY B N/A 1 1 001591221 03/011/2013 03/01/2014 FL B N/A 012948466 03/01/2013 03/01/2014 IL, KY, NC, NH, UT ' B N/A 012948467 03/01/2013 03/01/2014 AK, AZ, OA g N/A 012948468 03/01/2013 03/01/2014 NJ, PA ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD