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HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific Inc l ® DATE (MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 12/28/2015 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 Marsh USA Inc. NAME: FAX PHONE 1717 Arch Street A/c No Exq: Philadelphia, PA 19103-2797 E-MAIL SS, INSURER(S) AFFORDING COVERAGE _ NAIC # 424780-'ALL-GAW-16-17 _ INSURER A : Insurance Company Of The State Of PA 19429 INSURED INSURER B : ACE American Insurance Company 22667 BRENNTAG PACIFIC, INC. 10747 PATTERSON PLACE INSURER C : Indemnity Insurance Company of North America 43575 SANTA FE SPRINGS, CA 90670 INSURER D : Agri General Insurance Company 42757 INSURER E : ACE Fire Underwriters Co 20702 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-004767403-26 REVISION NUMBER: 12 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 POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY GL2638373 01/01/2016 01/01/2017 EACH OCCURRENCE _ $ 2,000,000 DAMAGE TO RENTED _ CLAIMS-MADE OCCUR PREMISES Ea occurrence 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ _ 2,000,000 X POLICY El PRO ❑ LOC PRODUCTS - COMP/OP AGG _ 2,000,000 JECT PRO- - OTHER: B AUTOMOBILE LIABILITY ISAH08867434 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ $ DED RETENTION $ C WORKERS COMPENSATION WLRC48600037(AOS) 01/01/2016 01/01/2017 X PER STATUTE OTH- ER AND EMPLOYERS' LIABILITY - B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WLRC48600049 (CA, NIA) 01/01/2016 01/01/2017 E L EACH ACCIDENT $ 2,000,000 N D OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) WLRC48600050 (TN) 01/01/2016 01/01/2017 E L DISEASE - EA EMPLOYEE $ 2,000,000 E If yes, describe under SCFC48600062 (WI) 01101/2016 0110112017 E L DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: SUPPLYING CHEMICALS TO BOTH THE WATER TREATMENT PLANT LOCATED AT: 90 N. MOUNTAIN AVENUE, ASHLAND, OR 97520 AND THE WASTE WATER TREATMENT PLANT LOCATED AT 1195 OAK STREET, ASHLAND, OR 97520. THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION, WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND, OR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: KARI OLSON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 NORTH MOUNTAIN AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _ Fi~nAe~~+ .mute- u. © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD