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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc ACORN ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY17 L~ 12/31/2014 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 Phone No.: (212) 488-0200 NCONTACT AME: Fax No.: (212) 488-0220 FAX WC, No. E.Q: (AC, N.): Frenkel & Company kADDRE AU u 350 Hudson Street - 4th Floor FKUUUUkK New York, NY 10014 CUSrOM1E2DA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: AIG 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 INSURER D: Riceboro GA 31323 INSURER 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 INSURANCE ~I SR SWVDR POLICY NUMBER POLICY EFF POMP EXP LTR LIMITS A GENERAL LIABILITY x EG14362834 12/31/2014 12/31/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED n OMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $ 500,000 CLAIMS MADE ~ 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 PRO- POLICY JECT LOC - $ B AUTOMOBILE LIABILITY x CA4691818 12/31/2014 12/31/2015 I COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 rx ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS AUTOSULED PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS $ A X UNBRELLALIAB X OCCUR x EGU18403155 12/31/2014 12/31/2015 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DIED RETENTION $ $ C WORKERS COMPENSATION 10WNR30600 12/31/2014 12/31/2015 X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE Y/ N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F] N/A (Mandatory in NFQ E.L. DISEASE- EA EMPLOYEE $ 1,000,000 IFyesdescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF -OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Add'Rional Remarks ScFredule,'If more space is required 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 90 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 ACCORDANCE WITH THE POLICY PROVISIONS 90 N. Mountain Avenue Ashland, OR 97420 AUTHORIZED REPRESENTATIVE 1 ©1988-2010 ACORD COR'P_60RATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD J l ® DATE(MM/DD/YYYY) ,ACC)Ro CERTIFICATE OF LIABILITY INSURANCE F12/31/2014 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 Phone No.: (212) 488-0200 CONTACT Fax No.: (212) 488-0220 NAME: PHONL FAX lac, Nq ExQ: (4"G N.N Frenkel & Company ADDRESS: 350 Hudson Street - 4" Floor I`KUUUUhK CUSTOMERIDA New York, NY 10014 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: AIG 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 INSURER D: Riceboro GA 31323 INSURER 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 INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR MR WVD A GENERAL LIABILITY x EG14362834 12/31/2014 12/31/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED $ 500,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 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-COMP/OP AGG $ 2,000,000 PRO- POLICY JECT LOC $ B AUTOMOBILE LIABILITY x CA4691818 12/31/2014 12/31/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED HIRED AUTOS AUTOS PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS $ A X UlvBRELLAUAB X OCCUR x EGU18403155 12/31/2014 12/31/2015 I EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ O WORKERS COMPENSATION 10WNR30600 12/31/2014 12/31/2015 X TO wCSTATU- ITH- AND EMPLOYERS' LIABILITY RY LIMITS Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? El N/A (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 tTIOunder i E.L. DISEASE - POLICY LIMIT $ 1,000,000 -DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule,'t morespace is required) 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. 90 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 ACCORDANCE WITH THE POLICY PROVISIONS 90 N. Mountain Avenue Ashland, OR 97420 AUTHORIZED REPRESENTATIVE / 1 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD