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HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific Inc DATE /YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 12/22/2014 /2014 ACO~~ `...-rte 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 CONTACT Marsh USA Inc. NAME: 1717 Arch Street PHONED t . n/c No): Philadelphia, PA 19103-2797 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 424780-'ALL-GAW-15-16 INSURER A : Insurance Company Of The State Of PA 19429 INSURED BRENNTAG PACIFIC, INC INSURER B : Greenwich Insurance Company 22322 . 10747 PATTERSON PLACE INSURER C : XL Specialty Insurance Company 37885 SANTA FE SPRINGS, CA 90670 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-003286428-24 REVISION NUMBER: 12 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 JUS& ADwVD DLSUBR POLICY NUMBER MMPOLICY EFF POLICY EXP /DD/YYYY MM/DD/YYYY LIMITS LTR A GENERAL LIABILITY GL 0696955 01101/2015 01/01/2016 EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE [Y] OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY RAD943713310 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT 11000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY $ TY DAMAGE HIRED AUTOS AUTOS r - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION RWR943509010 (WI) 01/01/2015 01/01/2016 X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS C ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N RWD943509110 (ADS) 01/01/2015 01/0112016 E.L. EACH ACCIDENT $ 2,000,000 C OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) RWD943544101 (AK) 0110112015 0110112016 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under 2,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: SUPPLYING CHEMICALS TO BOTH THE WATER TREATMENT PLANT LOCATED AT: 90 N. MOUNTAIN AVENUE, ASHLAND, OR 97520 AND THE WASTE WATER TREATMENT PLANT LOCATED AT 1195 OAK STREET, ASHLAND, OR 97520. THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION, WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND, OR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: KARI OLSON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 NORTH MOUNTAIN AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _ rau `ear, t,~tc+u~., e~ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 0003737 SP 0483 -C01-P03738-1 CITY OF ASHLAND, OR ATTN: KART OLSON 90 NORTH MOUNTAIN AVENUE ASHLAND, OR 97520