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HomeMy WebLinkAboutInsurance Certificate: UNIVAR USA Inc ACORO O4/2d2o1a ® CERTIFICATE OF LIABILITY INSURANCE OATE(MMDD YYY) 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 c certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 9O AOn Risk Services Central, Inc. NAME: Philadelphia PA Office (p!c iv .an: (866) 283-7122 NaC 800-363-0105 9`m One Liberty Place E-MAIL p 1650 Market street ADDRESS: -j Suite 1000 suite Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAICC INSURED INSURER A National Union Fire ins CO Of Pittsburgh 19445 UNIVAR USA INC INSURER B: New Hampshire Ins CO 23641 17425 NE Union Hill Road Redmond WA 980$2-3375 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570053018928 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 INSR LTR TYPE OF INSURANCE INSO VAID POLICY NUMBER MBDDVYYYYI VWD LIMITS A X COMMERCIAL GENERAL LIABILITY GL2802979 - 1 03/01/2015 EACH OCCURRENCE $3,000,000 CLAIMS-MADE ❑ OCCUR SIR applies per policy terns & condi ions $300,000 PREMISES Ea OCCUrIenn X SIR $2,000.000 MED EKE (Anyone Person) Excluded PERSONAL B ADV INJURY $3,000,000 n GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 53,000,000 m % POLICY ❑JEOT F~ LOC PRODUCTS. COMP!OP AGG $3,000,000 N 0 OTHER: c n A AUTOMOBILE LIABILITY CA 4806890 03/01/2014 03/01/2015 COMBINED DINGLE LIMIT $5,000,000 rruckeckers rs Liability (ADS). Its vcaaem , A % ANY AUTO ' CA 4806891 03/01/2014 03/01/201$ BODILYINJURY(Perpeacn) 2 ALL OWNED 5CHEDULED Truckers Liability (MA) BODILY INJURY (Per awdenl) 0 A AUTOS AUTOS CA 4806892 03/01/2014 03/01/2015 PROPERTY DAMAGE Is HIRED AUTOS AUTOS Truckers Liability (VA) Per 6eritlenl C C m L UMBRELLA UAB OCCUR EACH OCCURRENCE fl EXCESS UAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND W0001591220 03/01/2014 03/01/2015 X STATUTE OTH- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN ADS E. L. EACH ACCIDENT $1,000,000 A OFFICEWMEMBER EXCLUDED N/A WC1591222 03/01/2014 03/01/201$ (Mantlaloryin NH) CA, OH, OR & WA E. L. DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTIIPTIONOF SIR applies per policy terns & candi ions E L. OISEASE.POLICY LIMIT $1,000,D00- iN OF OPERATIONS baluw Es _ DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (ACORO 101, Aatliee,al Remarks acMtluM, may be amcMtl M more apace is nquiretl) RE: Bid #2008-101 & Bid 2008-102, Superfl OC N-300 LMW; Calcium Hypochlorite; caustic soda; sodium Hy ochlorite; SBS, Location: j 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. L s4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES W CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Ashland AUfHORRED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Avenue p ~A Ashland OR 97520 USA aJ/2~4Y ~itrxrd - AaJ fut c.Jrloss ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD f AGENCY CUSTOMER ID: 570000014538 LOC ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services central, Inc. UNIVAR USA INC POLICY NUMBER see certificate Number: 570053018928 CARRIER NAIC CODE See certificate Number: 570053018928 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 Ivnil information, refer to the corresponding policy on the ACORD certificate form for policy limits. POLIO.\' POINI' LTR R TYPE OF NSURASCE 1RSD ADOL M'VD SURD MLIO'NUMBER EFFECTIVE ESPIRA'1TON LIMITS LT DATE DATE \IMMDAINW MN1MD/YVVT AUTOMOBILE LIABILITY A CA 4806893 03/01/2014 03/01/2015 combined $5,000,000 commercial Auto (ADS) Single Limi A CA 4806894 03/01/2014 03/01/2015 Commercial Auto (MA) A CA 4806895 03/01/2014 03/01/2015 Commercial Auto (VA) WORKERS COMPENSATION B N/A W0001591223 03/01/2014 03/01/2015 MA, ND, WI, WY g N/A W0001591221 03/01/2014 03/01/2015 FL B N/A WC012948466 03/01/2014 03/01/2015 IL, KY, NC, NH, UT B N/A 1WC012948467 03/01/2014 1 AK, AZ, GA B N/A WC012948468 03/01/2014 03/01/2015 N1, PA ACORD 101 (2008101) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE . D82014 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) most 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). .c m PRODUCER COW T 4 AOn Risk Services Central, Inc. NAME: Philadelphia PA office (ANC Na. Est): (866) 283-7122 (NC Nng 800-363-0105 V p One Liberty Place E-MAIL 1650 Market street ADDRESS: _ suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAICis INSURED INSURER A National Union Fire Ins CO of Pittsburgh 19445 UNIVAR USA INC INSURER B: New Hampshire Ins CO 23841 17425 NE Union Hill Road Redmond WA 98052-3375 USA INSURER C: Illinois Union Insurance Company 27960 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570053020165 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 INSR LTR TYPE OF INSURANCE INSD vND POLICY NUMBER 'Pci-rcy L" POLICY xP MMIDDIYV, MMIDGNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 03/01/2015 [ME CH OCCURRENCE $3,000,000 CLAIMS-MADE X❑ OCCUR SIR applies per policy terns & condi ions 1300,000 EMISES fEa ommrenm X SIR: $2 000,000 D EXP (Anyone person) EXCI uded RSONAL a ADV INJURY 53,000,000 GEHL AGGREGATE LIMIT APPLIES PERNERAL AGGREGATE $3,000,000 POLICY ❑PRI ❑LOC ODUCTS-COMP/OP AGO $3,000,000 G OTHER: o A AUTOMOBILE LIABILITY CA 4806890 03/01/201403/01/2015 COMBINED SINGLE LIMIT 55000,000 m Truckers Liability (ADS) m A X ANY AUTO CA 4806891 03/01/2014 03/01/2015 BODILY INJURY( Per person) 2 ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY (Per amiden0 m q AUTOS NOAUTOS N-0WNED CA 4806892 03/01/2014 03/01/2015 PROPERTY DAMAGE Y HIRED AUTOS AUTOS Truckers Liability (VA) (Perawdent 0 C X UMBRELLA uqB X OccuR xcEG27380566001 03/01/2014 03/01/2015 EACH OCCURRENCE I 54,000,000 O UCESS LIAR CLAIMS-MADE AGGREGATE 54,000,000 DED X RETENTION 3500, 000 B WORKERS COMPENSATION AND W0001591220 03 O1 2014 03/01/2015 X STNTUTE OTH- EMPLOYERS' LIABILITY YIN N ACS TPROPRIETOR/PARTNERIEXECUiIVf N/A WC1591222 03/01/2014 03/01/2015 EL EACH ACCIDENT S1,000,000 A AN OFFICER/MELIBER EXCLUDEDi N IMan4atory in NlO CA, ON, OR $ WA EL. DISEASE-EA EMPLOYEE 51,000,000 Il yes descriCa under SIR applies per policy ter s 3 COndT ions EL DISEASE-POLICY' IMIT $I,OOD,000- DESCRIPTION OFOPERATIONS ~elow 1 a~ 3 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD tot, Ad4Rlo,ul Remarks Schedule, ,my M attlcMtl B,oo,e space is required) RE: Contract to supply water Treatment Chemicals, Ashland, city of waste water Treatment Plant. ylla Nda CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORQED REPRESENTATIVE Attn: Kari Olson 90 MDUntaRoad S Ashland OR 97520 USA JyQ.q /\//y 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY NAMEDINSURED ADD Risk Services Central, Inc. UNIVAR USA INC POLICY NUMBER see Certificate Number: 570053020165 CARRIER NAIC CODE see Certificate Number: 570053020165 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. POLIO' POLIO LNSR ADDL SUBR EFFECTIVE EXPIRATION LTR TYPEOFINSLRANCE INSD H'I'D POLICYNUMBER LIMITS DATE DATE NM/DD/I'4Yl' MADDDNY1N AUTOMOBILE LIABILITY A CA 4806893 03/01/2014 03/01/2015 Combined $5,000,000 Commercial Auto (AGE) Single Limi A CA 4806894 03/01/2014 03/01/2015 Commercial Auto (MA) A CA 4806895 03/01/2014 03/01/2015 Commercial Auto (VA) WORKERS COMPENSATION g N/A W0001591223 03/01/2014 03/01/2015 MA, ND, WI, WY B N/A W0001591221 03/01/2014 03/01/2015 FL B N/A WC012948466 03/01/2014 03/01/2015 IL, KY, NC, NH, UT B N/A WC012948467 0310112014 03/01/ZU15 AK, AZ, GA B N/A WC012948468 03/01/2014 03/01/2015 NJ, PA T ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo am registered marks of ACORD