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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc r ® DATE (MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 12/15/2015 THIS (:ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER-iIFICATE 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 Phone No.: (212) 488-0200 CO A NAME: Fax No.: (212) 488-0220 PHONE (AlC, No, Ems: (AC, No): Frenkel & Company AE-MAIL DDRESS: 350 Hudson Street - 4`h Floor CUSTONERII New York, NY 10014 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: AIG SPECIALTY INSURANCE COMPANY 26883 POlydyne Inc. INSURERB: COMMERCE & INDUSTRY INSURANCE COMPANY 19410 One Chemical Plant Road INSURERC: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 PO Box 250 INSURER D: Riceboro GA 31323 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP DON LTR INSR WVD jmw -_MDD(YYYYI A GENERAL LIABILITY XX EG14362834 12/31/2015 12/31/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $ 500,000 CLAIMS MADE C OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 17 PRO- LOC $ _ JECT B AUTOMOBILE LIABILITY XX CA4691818 '12/31/2015 12/31/2016 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS AUTOSULED PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS i $ A UMBRELLAUAB X OCCUR EGU18403155 12/31/2015 12/31/2016 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR CLAiMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS C WORKERS COMPENSATION 1OWNR30600 1 12/31/2015 12/31/2016 X W- OTH- _ ~R AND EMPLOYERS' LIABILITY / N _ TORY Y LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 Iryesdescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland is included as Additional Insured under General Liability, Automobile Liability and Excess/Umbrella Liability coverage as required by contract with respect to liability arising out of the operations of the Named Insured, as their interest may appear, and subject to the policy terms conditions and exclusions. Coverage applies on a primary and non-contributory basis as required by contract and subject to the policy terms conditions and exclusions. RE: Polymer - Clarifloc C-6286 30 DAY CANCELLATION CLAUSE INCLUDED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS Ashland, OR 97420 AUTHORIZED REPRESENTATIVE r` © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/15/2015 THI-!-ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER'FICATE 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 Phone No.: (212) 488-0200 co A Fax No.: (212) 488-0220 NAME: AX (A/C, No, Ed): Frenkel & Company ADDRESS: 350 Hudson Street - 4`h Floor CUSiOkERDfk New York, NY 10014 INSURER(S) AFFORDING COVERAGE NAICq INSURED INSURER A: AIG SPECIALTY INSURANCE COMPANY 26883 POlydyne Inc. INSURERS: COMMERCE & INDUSTRY INSURANCE COMPANY 19410 One Chemical Plant Road INSURER C: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 PO Box 250 INSURER D: Riceboro GA 31323 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSR WVD ! POLICY NUMBER IMMIDDIYYYYI (MMIDDIYYYY1 LIMITS A GENERAL LIABILITY xx EG14362834 1213112015 12131/2016 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 7] JRO- PECT LOC $ B AUTOMOBILE LIABILITY XX CA4691818 12/31/2015 12/31/2016 COMBINED S INGLE LIMIT (Ea accident) $ 1,000,000 j X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X_ HIRED AUTOS AUSCHEDULED PROPERTY DAMAGE X NON-OWNED (Per accident) $ AUTOS $ A UMBRELLALIAB X OCCUR EGU18403155 12/31/2015 12/31/2016 ! EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ _ $ C. WORKERS COMPENSATION ! 1OWNR30600 12/31/2015 12/31/2016 XX TORY LIMITS OT AND EMPLOYERS' LIABILITY Y I N $ 1,000'000 I ANY PROPRIETORIPARTNER/FXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? El N/A (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 Ifyesdescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 I I DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule,'rf more space is required) City of Ashland is included as Additional Insured under General Liability, Automobile Liability and Excess/Umbrella Liability coverage as required by contract with respect to liability arising out of the operations of the Named Insured, as their interest may appear, and subject to the policy terms conditions and exclusions. 30 DAY CANCELLATION CLAUSE INCLUDED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS Ashland, OR 97420 AUTHORIZED REPRESENTATIVE 1 f f c'-. i e G- :S © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD