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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc (3) 'CERTIFICATE OF LIABILITY INSURANCE ly. 1: ACORO F_2,'10,'20'14.,, TE NooYYYY 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'AFF_ORDED BY THE POLICIES-'- BELOW-THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ASSUING INSURER(S),-AUTHORIZED-17 REPRESENTATIVE'OR PRODUCER, AND THE CERTIFICATE HOLDER. rsD 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 No.: (212) 488-0200 NAME: Fax No.: (212) 488-0220 psC.NAExtI' ytc,Ny Frenkel & Company E-NIMLes, 350 Hudson Street - 4'" Floor asroeeeoc New York, NY 10014 INSWEwB)AfFORLYNG f.OYERAGE NAICY INSURED INSURER A, CHARTIS SPECIALTY INSURANCE COMPANY 26883 POlydyne Inc. INSURER B: COMMERCE S, INDUSTRY INSURANCE COMPANY 19410 One Chemical Plant Road INSURERC: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 PO Box 250 INSURER O: Riceboro GA 31323 INSURER E: NSURER 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. - IN TYPEOFIN3URANCE' r✓» Sip' - -POLICY NUMBER PO VEFF POl1LY EXP LIMITS _ ADOC LTR Aa GENERAL LIABILITY('''. +X", •+o , EG14362834 ._...,12/31/2013... 12/31/2014., _EACH,000URRENCE., 1,000,000 t X 1G • V T r 'OLL I IL(IC - DAMAGE To RENTED -COMMERCIAL GENERAL LIABILnY PREMISES Ea ocwrrance ' $ 500;000 • +I Ell CLAHAVMADE- aX. O' CCUR ' MED EXP (Any one person) $ 10,000 lAc Ou :fig: C " ,•Y," _ri >J'a - +r - 'F PERSONAL'&ADV INJURY 1,000,000 11 NI^ v (^:,hri'1 e.: 6' COP.., GENERALAGGREGATE 5000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 PRO- N:71 F7 .POLICY ,CT L. ( + .1 $ 13 AUTOMOBILE LIABILITY x CA4691818 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT Ea aaoiden0 $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ x HIRED AUTOS A SCHEDULED UTO$ PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS $ A XIINHRELL kLAB X OCCUR x EGU18403155 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1.000.000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS $ C WORKERS COMPENSATION 1OWNR30600 - 12/31/2013 12131/2014 X TORY LAMITS ER AND EMPLOYERS' LABILITY ANY PROPRIETOR,PARTNER:EXECUTNE YIN E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Maldetay In Nil) EL DISEASE-EA EMPLOYEE $ 1,000,000 ryasdesan0e under N OPERATION E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ANecJ, ACORD 101, Addtier,el Remaks SUedub, 1. specs b ne,.W d) 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. Coverage applies on a primary and non-contributory basis as required by contract and subject to the policy terms conditions and exclusions. RE: Polymer - Clarifloc C-6286 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 HORIZEDREPRESENrk VE 1 © 1988- j 0 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOTICE TO CERTIFICATE HOLDERS See attached updated Certificate of Insurance to reflect change to Excess Umbrella Named Insurer to retain for your records. i A` & CERTIFICATE OF LIABILITY INSURANCE 57"N"Goia 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 No.: (212) 488-0200 NANE: Fax No.: (212) 488-0220 Tirnop, tAcli 0ex I NSNi Frankel & Company Anlxffie: 350 Hudson Street - 4In Floor ~~K New York, NY 10014 INSUREgIS1 AFFDRdrvc mYeRADE NAlco INSURED INSURER n: CHARTIS SPECIALTY INSURANCE COMPANY 26883 POlydyne Inc. INSURER B: COMMERCE & INDUSTRY INSURANCE COMPANY 19410 One Chemical Plant Road INSURER C: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 PO Box 250 e15URER D Riceboro GA 31323 INBURER E: 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 TYPE OF W$URANCE $SUBR POLICYNUMBER POLICY EFF PDUCYEXP LTR A GENERAL LIABILITY X EG14362834 12/3112013 12131/2014 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED $ 500,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS MADE [ X] 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-COMP/OP AGG $ 2,000,000 POLICY JECT LOC $ B AUTOMOBILE LIABILITY x CA4691818 12131/2013 12/31/2014 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accidenq X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS AUTOSULEO PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS A X LNER UAB X OCCUR X EGU18403155 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 EXCESS LAB CUJNS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ C WORKERS COMPENSATION 1OWNR30600 12/3112013 1213112014 X TORYLIMITS ER AND EMPLOYERS LUSILm' ANY PROPRIETOR/PARTNER,EXSCUTNE YIN E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ NIA (MNdeftsy In MI) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 ry®describe under DE~QElRJlQN E.L. DISEASE-POLICY LIMIT $ 1,000,000 OE$CRPTxIN OF OPEAATKINB I LOCATpNBI VBeCLE$ IAVxN ALORD t01, AddebMl Remark+5tl,etlule, rmNe apep h repaired) 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 ORIZED REPRESr~ t © 1988- j D ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOTICE TO CERTIFICATE HOLDERS See attached updated Certificate of insurance to reflect change to Excess Umbrella Named Insurer to retain for your records.