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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc A~ CERTIFICATE OF LIABILITY INSURANCE 1?J31/2013 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(les) 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 ND.: (212)488-0200 NAME: Fax No.: (212) 488-0220 PHONE IN4 N4 ENI: IM.' Nc1 Frankel & Company AH_ ADDRESS 350 Hudson Street - 4t" Floor ~OMSUDA New York, NY 10014 INSURER(S) AFFORDING COVERAGE NAICY INSURED INSURER A, ChadisSpecialty Insurance Company 26883 POlydyneInc. INSURER B: Commerce & Industry Insurance Company 18410 One Chemical Plant Road INSURER C: Hartford Insurance Company of the Midwest 37478 PO Box 250 INSURER D: National Union Fire Insurance Company of Pittsburgh PA 18445 Riceboro GA 31323 INSURERS 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSUFLNCE SADDI. R NUNBDR POLICY NUMBER POl1CYEFF POLICYE%P UNITS IMNM]DnnYD A GENERAL LIABILITY x EG14362834 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED $ 500,000 OMMERCIAL GENERAL LIABILITY PREMISES Ea pmurrence CLAIMS MADE FX-] OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLIOY JEiT 71 LOC $ B AUTOMOBILE LIABILITY x CA4691818 12/31/2013 12/3112014 CouBINEDSINGLE LIMIT $ 1,000,000 Ee ealdem X ANYAUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per aCud.pt) $ X HIRED AUTOS AUTOSULED PROPERTY DAMAGE X NON-OWNED (Per acoiden0 $ AUTOS $ D X U.ERE UAJB X OCCUR x 13273528 12131/2013 1213112014 EACH OCCURRENCE $ 1,000,000 EXCESS UA9 CLAIMS-MADE AGGREGATE $ 1,000,000 DEC) RETENTION $ $ ATU Q WORKERS COMPENSATION 1OWNR30600 12/31/2013 12/31/2014 X W&SLIMITS ER AND EMPLOYERS' UABILRY ANY PROPRIETORPARTNERIEXECUTNE YIN E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N/A niMndlwyln NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 ffedescribe under E. L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATONS w DESCN NOFOPEMMnILOCAMMIYEHICLES(Atpcb=om 101,Addiu Xdl Remrke Sctetlule,Mn,wayua 6npulred) City of Ashland is included as Additional Insured under General Liability, Automobile Liability and Excess/Umbrella 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. 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 A ORUD REPRESE7 1 ©1988- 1O ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of RCORD