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HomeMy WebLinkAboutInsurance Certificate: Univar Inc (2) ACS ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02127/2015 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 m NAME: Aon Risk Services Central, Inc. Philadelphia PA Office (A/C No.Ext): (866) 283-7122 ac No): 800-363-0105 0 One Liberty Place E-MAIL 0 1650 Market street ADDRESS: suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 Uni Var Inc. INSURER B: New Hampshire Ins CO 23841 3075 Highland Parkway suite 200 INSURER C: Downers Grove IL 60515 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570056943297 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 SUBR LTR TYPE OF INSURANCE INADDL SD WVD POLICY NUMBER MPOLICY I:FF PUUUY LAP MIDDIYYYY MWDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL2802979 U3/01/2015 06101T2-0-1-6 EACH OCCURRENCE $3,000,000 CLAIMS-MADE Fx] occuR SIR applies per policy terns & conditions DAMAGE $300,000 PREMISES Ea occurrence) X SIR: $2,000,000 MED EXP (Any one person) Excluded PERSONAL &ADV INJURY $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- X POLICY ❑ JECT LOC PRODUCTS - COMP/OP AGG $3,000,000 00 OTHER: ° 0 n A AUTOMOBILE LIABILITY CA 4806890 03/01/2015 06/01/2016 COMBINED SINGLE LIMIT $5,000,000 Truckers Liability (ADS) Ea accident Z A X ANY AUTO CA 4806891 03/01/2015 06/01/2016 BODILY INJURY ( Per person) O ALL OWNED P SCHEDULED Truckers Liability (MA) BODILY INJURY (Per accident) m A AUTOS AUTOS CA 4806892 03/01/2015 06/01/2016 R HIRED AUTOS NON-OWNED PROPERTY DAMAGE v AUTOS Truckers Liability (VA) Per accident r m A UMBRELLA LIAR HOCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION oTH- EMPLOYERS'LIABILITY ORKERS COMPENSATION AND W0001591220 03/01/2015 03/01/2016 X STATUTE IER B W ANY PROPRIETOR/ PARTNER/ EXECUTIVE YIN A05 A OFFICER/MEMBEREXCLUDED? ~ NIA WC1591222 03/01/2015 03/01/2016 E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) CA, OH, OR & WA E.L. DISEASE-EA EMPLOYEE $1,000,000 I f s , describe under DESCRIPTION OF OPERATIONS below SIR applies per pol icy =I & C I i ons E.L. DISEASE-POLICY LIMIT $1,000,000 - -S ~i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 107, Additional Remarks Schedule, may be attached H more space is required) RE: Bid #2008-101 & Bid 2008-102, superfloC N-300 LMW; Calcium Hypochlorite; Caustic Soda; Sodium Hy ochlorite; SBS; Location: W 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. is 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 Avenue 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 AC~RO® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services Central, Inc. univar Inc. POLICY NUMBER See Certificate Number: 570056943297 CARRIER NAIC CODE See Certificate Number: 570056943297 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. INSR ADDL SUBR POLICY POLICY LTR TYPE OF INSURANCE ~,SD wVD POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE DATE MM/DD/YYYY MM/DD/YYYY AUTOMOBILE LIABILITY A CA 4806893 03/01/2015 06/01/2016 Combined $5,000,000 Commercial Auto (AOS) Single Limi A CA 4806894 03/01/2015 06/01/2016 Commercial Auto (MA) A CA 4806895 03/01/2015 06/01/2016 Commercial Auto (VA) WORKERS COMPENSATION B N/A wc001591223 03/01/2015 03/01/2016 MA, ND, WI, WY B N/A W0001591221 03/01/2015 03/01/2016 FL B N/A wCO12948466 03/01/2015 03/01/2016 IL, KY, NC, NH, UT B N/A wc012948467 5 1 1 AK, AZ, GA B N/A wc012948468 03/01/2015 03/01/2016 NJ, PA ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD