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HomeMy WebLinkAboutInsurance Certificate: Univar USA Inc (3) ® CERTIFICATE OF LIABILITY INSURANCE °A'~'~°°a""' 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 ,2 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT m Aon Risk Services Central, Inc. NAME. S Philadelphia PA Office (AC NMo. Eag: (866) 283-7122 INC 800-363-0105 m One Liberty Place E-MAIL p 1650 Market Street ADDRESS: 2 Suite 1000 Philadelphia PA 19103 USA INSURERIS) AFFORDING COVERAGE NAtCM 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 INSURERC: 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 AD SUER LTR TYPE OF INSURANCE INSD O POLICY NUMBER MMIDO MMIODIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL U3/01/2015 EACHOCCURRENCE $3,000,000 CLAIMS-MADE XM OCCUR SIR applies per policy terns & condi ions $300,000 PREMISES IEaocrunen¢ X SIR: S2,000,000 MED UP (Anyone person) EXCluded PERSONAL S ADV INJURY $3,000,000 ry GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 53,000,000 m X POLICY ❑JEQ ~LOC PRODUCTS - COMPIOP AGO $3,000,000 mi OTHER: ° 0 r Tr b A AUTOMOBILE LIABILITY 4806890 03/01/201403/O1/201$ COMBINED SINGLE LIMIT $5,000,000 Truckers Liability (ADS) Eae .e nt A X ANY AUTO CA 4806891 03/01/2014 03/01/2015 BODILY INJURY I Per person) _ ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY (Per acadent) 0 A AUTOS AUTOS CA 4806892 03/01/2014 03/01/2015 HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Truckers Liability (VA) Peraoddent 1 e UMBRELLA LIAB H OCCUR EACH OCCURRENCE U EXCESS LIAR CIAIMS-MADE AGGREGATE DED RETENTION B YJOPRKOEYRS C LPPEENATION AND YIN W00001591220 03/0120140301/2015 X STATUTE 124H_ EM' PROPRIETOR) PARTNER/EXECUTIVE E.L. EACH ACCIDENT 51,000,000 A OFFICE "EMBER EXCLUM07 NIA WC1591222 03/01/2014 03/01/2015 (Mandatory in NM CA, ON, OR & WA EL DISEASE-EA EMPLOYEE $1,000,000 If yes, desmee under DESCRIPTION OF OPERATIONS below SIR applies per. policy terns & condi ions E.L. DISEASE-POLICY LIMIT $1,000,000- . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGGRO 101, AtltliYOwl Rermrka Schedule, may M eaacM1e4 if more apace is raquiretl) RE: Bid $2008-101 & Bid 2008-102, Superfl OC N-300 LMW; Calcium Hypochlorite; Caustic soda; sodium myrchlorite; 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 rrr 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE 6MLL BE DELIVERED IN ACCORDANCE WITH THE _ POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Avenue Ashland OR 97520 USA )jy W. o ~i ~ 01988-201144 ACORD CORPORATION. JAII rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC `°RO ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. UNIVAR USA INC POLICY NUMBER see certificate Number: 570053018928 CARRIER NAIL CODE see certificate Number: 570053018928 EFFECTNE 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 PIRAIJ INSIR UIR AUUL W SUBIR EFAE(TIVE ESDATE ON CrR TYPE OFINSURANCE INSD N'%o \'U POLIC\'NU NUMBER LIMITS DATE DATA. 11A1/DD/1'\"V\' M)1/DD/1'\'\T AUTOMOBILE LIABILITY A CA 4806893 03/01/2014 03/01/2015 combined 45,000,000 Commercial Auto (AOS) Single Limi A CA 4806894 03/01/2014 03/01/2015 Commercial Aura (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 B N/A W0001591221 03/01/2014 03/01/2015 FIL B N/A wc012948466 03/01/2014 03/01/2015 IL, KY, NC, NH, UT B N/A WC012948467 WM77M TT/n7= AK, AZ, CA B N/A WC012948468 03/01/2014 03/01/2015 NJ, PA ACORD 707(2008101) 02008 ACORO CORPORATION. All rights reserved. The ACORD name and logo are registered manse of ACORD ® CERTIFICATE OF LIABILITY INSURANCE DATE(MNVOO14 W) o2rzerzD 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 2 Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'O NAME: ADD Risk Services Central, Inc. PHONE (g66) 283-7122 FA% 800-363-0105 0 Philadelphia PA Office L.. Na. E.D: Arc. No.: One Liberty Place E-MAIL p 1650 Market street ADDRESS: x suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: National Union Fire Ins CO of Pittsburgh 19445 UNIVAR USA INC INSURER 8: New Hampshire Ins Co 23841 17425 HE Union Hill Road Redmond WA 98052-3375 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 LTR TYPE OF INSURANCE INSO MD POLICY NUMBER MMI 0 MMIO LIMITS A % COMMERCIAL GENERAL LIABILITY GL2802979 03/01/2014 03/01/2015 EACH OCCURRENCE $3,000,000 CLAIMS-MADE OCCUR SIR applies per policy terns & condi ions 5300,000 PREMISES Ea o=Teme X SIR:$2,001),000 MEDE%Pi"yoeepemon) EXCluded PERSONAL&ADV INJURY 53,000,000 H GEN'L AGGREGATE LIMIT APPLIES PER G ENERAL AGGREGATE 53,000,000 ne X POLICY ❑PECT ❑LOD PRODUCTS - COMPIOP AGG 53,000,000 OTHER: o r A AUTOMOBILE 11A80JTY CA 4806890 03/01/2014 03/01/201$ COMBINED SINGLE LIMB Truckers Liability (A05) nL_ 55,000,000 A X ANY AUTO CA 4806891 03/01/2014 03/01/2015 BODILY INJURY (Per person) _ ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY (Per acdden0 e A AUTOS AUTOS CA 4806892 03/01/2014 03/01/2015 m HIREDAUTOS NON-0WNED PROPERTY DAMAGE O AUTOS Truckers Liability (VA) (Perarddem C 0 UMBRELLAU OCCUR EACH OCCURRENCE L) EXCESS LIAR CLAIMS-MADE AGGREGATE AB H DED RETENTION B WORKERS COMPENSATION AND W0001591220 03/01/2014 03/01/201$ X PER OTH- EMPLOYERS'UABILNY YIN AIDS STATUTE ANYPROPmEfORIPARTNERIEYECUTIVE E. L. EACH ACCIDENT 51,000,000 A OFF, EWMEMBER EXCLUDED? NIA WC1591222 03/01/2014 03/01/2015 (Mandatoryin NM CA, OH, OR & WA E.L. DISEASE-EA EMPLOYEE $1,000,000 IIy deacnEe under DESCRIPTION OF OPERATIONS below SIR applies per policy terns & CODdI (COS E. L. DIGEABEPOLICY LIMIT $1,000,000- 0 DESCRIPTION OF OPERATIONS l LOCATX)NS I VEHICLES (ACORO 101, Ad4i4onal Remade Sobadup, may be atMCMd B mor. space is raquintl) 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 A 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 MLL BE DEWERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Avenue Ashland OR 97520 USA t _ - p~ ©1988--2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC cage _ of _ ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED ADO Risk services central, Inc. UNIVAR USA INC POLICY NUMBER see certificate Number: 570053018928 CARRIER NAIC CODE see certificate Number: 570053018928 EFFECTNE 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. POLICI' POLICY 1NSR AUDL SUER INS R NNU EFFECTIVE EXPIRATION LIMITS TYPE OF INSURANCE POLICI'NUMBER DATE DATE MM/DDAIl MMAIDA ' T AUTOMOBILE LIABILITY A CA 4806893 03/01/2014 03/01/2015 Combined 55,000,000 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, N0, WI, WY R 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 03/01/ZU14 03/01/2015 AK, AZ, GA e N/A WC012948468 03/01/2014 03/01/2015 NJ, PA T-' I ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserrea. The ACORD name and logo are registered marks of ACORD