Loading...
HomeMy WebLinkAboutInsurance Certificate: Andritz Separation YW) CERTIFICATE OF LIABILITY INSURANCE F DAT05/27/2015 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). m CONTACT C PRODUCER NAME: Aon Risk Services Central, Inc. PHONE 800-363-0105 Philadelphia PA Office (A/C. No. Ext): (866) 283-7122 FAA/Cx . No.): one Liberty Place E-MAIL o 1650 Market street ADDRESS: _ Suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Mutual Fire Ins Co 23035 Andritz Separation Inc. INSURER B: Liberty Insurance corporation 42404 1010 Commercial Blvd., South INSURER C: Arlington Tx 76001 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570057798760 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 IN SR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY FF POLICY EX LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY TB 51 4 41 5 1 1 7771777"T EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $1,000,000 CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence MED EXP (Any one person) $5,000 PERSON AL&ADV INJURY $1,000,000 r rn GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $1,000 , 000 co X POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $1,000,000 JECT 00 OTHER: r As2-651-004304-035 06/ 01/2015 06/01/2016 COMBINED SINGLE LIMIT '4 AUTOMOBILE LIABILITY Ea accident $1,000,000 BODILY INJURY ( Per person) O X ANY AUTO Z ALL OWNED SCHEDULED BODILY INJURY (Per accident) N R AUTOS AUTOS PROPERTY DAMAGE U HIRED AUTOS NON-OWNED AUTOS Per accident) 0) UMBRELLA LIAB HOCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION ER B WORKERS COMPENSATION AND WA76SDO04304135 06/01/2015 06/01/2016 X STATUTE OH EMPLOYERS' LIABILITY Y / N (ADS) ANY PROPRIETOR/PARTNER/EXECUTIVE WC7651004304145 06/01/2015 06/01/2016 EL. EACH ACCIDENT $1,000,000 B OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) (WI) E.L. DISEASE-EA EMPLOYEE $1,000,000 000 - If yes, describe under n-CR EL DISEASE-POLICY I IMIT $1,000, IPTIn I,f OF OPEP_GTI!1N DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) z RE: ASI Project 1195. The City of Ashland, Oregon and its elected officials, officers and employees are included as Additional Insured on the General Liability and Automobile Liability policies, if required by written contract with Certificate - Holder and subject to the policy terms, conditions and exclusions. 11111110-9 CERTIFICATE HOLDER CANCELLATION .;1-: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ~Jt EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _ City of Ashland AUTHORIZED REPRESENTATIVE 20 East main street ~l p Ashland OR 76001 USA can ~f%~:tQ/c ~sb~d ~~ao~zL~ifi ~na ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD