HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific
DATE YYYY)
AC>R°® CERTIFICATE OF LIABILITY INSURANCE 11127 12013
12013
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:
HONE ac Na
1717 Arch Street P
(A/C, No. Extl-
Philadelphia, PA 19103-2797 E-MAIL
ADDRESS;
INSURERS AFFORDING COVERAGE NAIC0
4247W*ALL-GAW-14-15 INSURER A : Insurance Company Of The State Of PA 19429
INSURED INSURER B : GreenvACh Insurance Company 22322 BRENNTAG 10747 PATPACIFIC, INC. XL Specialty Insurance Company 37885
10747 TERSON PLACE INSURER C
SANTA FE SPRINGS, CA 90670 INSURER D :
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: CLE-003286527-23 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 NTH 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.
ILTR R TYPE OF INSURANCE ADDLSUER POLICY NUMBER MMIDDY fYYYY MN/DDIYYYY LIMITS
A GENERAL LIABILITY 0696955 0110112014 01101/2015 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMA E T RENTED 1,000,000
PREMISES Ea oavnence E
CLAIMS MADE O OCCUR MED EXP (Any 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 AGG $ 1,000.000
X POLICY PRO- LOC $
B AUTOMOBILE LIABILITY RAD943713309 (ADS) 01/0112014 01/0112015 COMBINED SINGLE LIMIT 1,000,000
Ea accldent1
B X ANY AUTO RAD943713109 (MA) Ol/01/2014 01/0112015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTYDAMAGE $
HIRED AUTOS AUTOS Per eccidanl
UMBRELLA DAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
C WORKERS COMPENSATION RWR943509009(WI) 01/01014 01/0112015 X WC STATU- OTH-
ANDEMPLOYERT1JABRJTY 1 TORY LIMITS C ANY PROPRIETORIPARTNERIEXECIITIVE YIN RWD943509109 (ADS) 011010014 0110712015 2,000,000
C OFFICER/M (Mandatory In EMBE NH) R E%CLODED9 NN N/A RWD9435441 0110112014 01101015 EEL. L. EACH DISEASE - EA ACCIDENT EMPLOYE $ E 2,000,000
.
If yas, do.be under 2,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarlm Schedule, If more space Is required)
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 Mukhegee -MJA+..ao',: ca.and-ca-
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD