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HomeMy WebLinkAboutInsurance Certificate: Chem Quip Inc ACC) " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) lli, '6/29/2015 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 endorsements . PRODUCER NCONTACT AME., Michelle Goodwin InterWest Insurance Services PHONE 831-635-2447 FAX 831-638-6801 License #0601094 'Air, No Ext)- E 222 Court Street m9oodwin@iwins.com Woodland CA 95695 INSURERS AFFORDING COVERAGE NAIC # INSURER A:West American Ins. Co. 44393 INSURED CHEMQ-1 INSURERB:Amerlcan Fire & Casualty Co 24066 Chem Quip Inc. INSURER C: Insurance Co. of the West 27847 2551 Land Ave. INSURER D: Sacramento CA 95815 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1847498367 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY BKW56035070 4/1/2015 4/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ~X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT [ X~ LOC PRODUCTS - COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAA56035070 4/1/2015 4/1/2016 COMBINED IN LE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ B X UMBRELLA LIAB X OCCUR USA56035070 4/1/2015 4/1/2016 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION $10,000 $ C WORKERS COMPENSATION WSA500615604 411/2015 4/1/2016 X STATUTE OERH AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Business Pers Property BKW56035070 4/1/2015 4/1/2016 Blanket 6,050,000 Deductible 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION "10 days for non payment of premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE b "~_~(?,d-.vf~c C'l~D~•c~nbututi © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD