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HomeMy WebLinkAboutInsurance Certificate: Univar Inc CERTIFICATE OF LIABILITY INSURANCE DATED~2~DOD5YW) 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 m 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). m PRODUCER CONTACT 'p Aon Risk services central, Inc. NAME: Philadelphia PA Office (AIC.. No. Ext): (866) 283-7122 (ac. No.): 800-363-0105 one Liberty Place E-MAIL o 1650 Market street ADDRESS: _ suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Illinois Union Insurance Company 27960 Univar Inc. INSURER B: National Union Fire Ins CO Of Pittsburgh 19445 3075 Highland Parkway Suite 200 INSURER C: New Hampshire ins Co 23841 Downers Grove IL 60515 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570056945194 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 SUBRI LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY GL OT/71-/2015 06/01/2016 EACH OCCURRENCE $3,000,000 CLAIMS-MADE X❑ OCCUR SIR applies per policy terns & conditions DAMAGE $300,000 PREMISES Ea occurrence MED EXP (Any one person) EXCI tided X SIR: $2,000,000 PERSONAL &ADV INJURY $3,000,000 0, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S3,00 X POLICY ❑ PRO ❑ LOG PRODUCTS - COMP/OP AGG $3,000,000 to JECT 0 OTHER: r B AUTOMOBILE LIABILITY CA 4806890 03/01/2015 06/01/2016 COMBINED SINGLE LIMIT S5,000,000 N Truckers Liability (ADS) Ea accident B X ANY AUTO CA 4806891 03/01/2015 06/01/2016 BODILY INJURY ( Per person) 0 Z ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY (Per accident) m B AUTOS AUTOS CA 4806892 03/01/2015 06/01/2016 PROPERTY DAMAGE u HIRED AUTOS NON-OWNED AUTOS Truckers Liability (VA) Per accident Is m A X UMBRELLALIAB X OCCUR XCEG27380566002 03/01/2015 06/01/2016 EACH OCCURRENCE $4,000,000 rJ SIR applies per policy terns & condl ions EXCESS L CLAIMS-MADE AGGREGATE $4,000,000 IAR DEC) X RETENTION C WORKERS COMPENSATION AND W0001591220 03/01/2015 03/01/2016 X STATUTE OTH- EMPLOYERS' LIABILITY B ANY PROPRIETOR / PARTNER / EXECUTIVE YIN AOS E.L. EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? N NIA WC1591222 03/01/2015 03/01/2016 (Mandatory in NH) CA, OH, OR & WA E.L. DISEASE-EA EMPLOYEE $1,000,000 yes, describe under - DESCRIPTION OPERATIONS below SIR applies per policy ter S & Condi l ons E.L. DISEASE-POLICY LIMIT $1,000,000 Dyes, de DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Contract to Supply Water Treatment Chemicals, Ashland, City of waste water Treatment Plant. - fF. ~a xi 6 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. mountain Road ~y tC~~f~ f CJGl~1 Y Ashland OR 97520 USA ©1988-2014 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 Aon Risk services central, Inc. Univar Inc. POLICY NUMBER see certificate Number: 570056945194 CARRIER NAIC CODE see certificate Number: 570056945194 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. POLICY POLICY TVSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER EFFECTIVE EXPIRATION LIMM DATE DATE MM/DD/YYYY MM/DD/YYYY AUTOMOBILE LIABILITY B CA 4806893 03/01/2015 06/01/2016 Combined 85,000,000 Commercial Auto (ADS) Single Limi B CA 4806894 03/01/2015 06/01/2016 Commercial Auto (MA) B CA 4806895 03/01/2015 06/01/2016 Commercial Auto (VA) WORKERS COMPENSATION C N/A W0001591223 03/01/2015 03/01/2016 MA, ND, WI, WY C N/A wc001591221 03/01/2015 03/01/2016 FL C N/A WC012948466 03/01/2015 03/01/2016 IL, KY, NC, NH, UT C N/A wc012948467 UT/1-/15 1 O1 AK, AZ, GA C N/A WC012948468 03/01/2015 03/01/2016 NJ, PA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD