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Home My WebLink AboutInsurance Certificate: Univar Inc (4) ACS ® DATE( 021/24/22016 W) CERTIFICATE OF LIABILITY INSURANCE 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 w certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT D NAME: Aon Risk Services Central, Inc. L Phi 1 adel phi a PA Office PHONNoE. Ext): (866) 283-7122 jAIC No 800-363-0105 a) One Liberty Place E-MAIL p 1650 Market Street ADDRESS: _ Suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Illinois union insurance company 27960 Uni var Inc. INSURER B: National Union Fire Ins co of Pittsburgh 19445 3075 Highland Parkway suite 200 INSURER C: New Hampshire Ins Co 23841 Downers Grove IL 60515 USA INSURER D: INSURER E: INSURER F: C 0VEE AG, CERTIF!CATcE N.,.M P• G70961258758 REVISION NUMBER: G~ C U,..R ~E 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 TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY POLICY EXP LIMITS LTR INSD WVD MM/DD/ F MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY GL 1 15 1 1 EACH OCCURRENCE $3,000,000 SIR applies per policy terns & conditions DAMAGE TO RENTED $300,000 CLAIMS-MADE ❑ OCCUR PREMISES Ea Occurrence MED EXP (Any one person) EXCI uded X SIR: $2,000,000 PERSONAL & ADV INJURY $3,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 co LOC PRODUCTS - COMP/OP AGG $3,000,000 X POLICY ❑ PE O F7 0 OTHER 0 r B AUTOMOBILE LIABILITY CA 4806890 103/01/2015 06/01/2016 Ea aCOMBINccideEDnt SINGLE LIMIT $5,000'000 Truckers Liability (ADS) B X ANY AUTO CA 4806891 03/01/2015 06/01//2016 BODILY INJURY ( Per person) 0 ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY (Per accident) v B AUTOS AUTOS CA 4806892 03/01/2015 06/01/2016 PROPERTY DAMAGE M HIRED AUTOS NON-OWNED AUTOS Truckers Liability (VA) (Per accident) A X UMBRELLA LIAB X OCCUR XCEG27380566002 03/01/2015 06/01/2016 EACH OCCURRENCE $4,000,000 L) EXCESS LIAB CLAIMS-MADE SIR applies per policy terns & conditions AGGREGATE $4,000,000 DED X RETENTION C WORKERS COMPENSATION AND WC021569602 03/01/2016 06/01/2016 X PER OTH- EMPLOYERS' LIABILITY Y / N AOS STATUTE ER ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $1,000,000 B OFFICER/MEMBER EXCLUDED? N N/A XWC0898944 03/01/2016 06/01/2016 (Mandatory in NH) CA, OH, OR & WA E L DISEASE-EA EMPLOYEE $1,000,000 yes describe under - DESCRIPTION OF OPERATIONS below SIR applies per policy terns & condi ions E1 DISEASE-POLICY LIMIT $1,000,000 D I~ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: contract to supply water Treatment Chemicals, Ashland, city of waste water Treatment Plant. S_ IG. ■ ti W 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. ~y City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 Mountain Road cXX c J~V ~ ~ Ashland OR 97520 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC A~O'RD® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER See Certificate Number: 570061258758 CARRIER NAIC CODE See Certificate Number: 570061258758 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 ENSURER 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. POLICY POLICY INSR ADDL S£BR EFFECTIVE EXPIRATION LTR TYPE OF INSLRANCE INSD N'YD POLICY NL'YIBER LI111TS DATE DATE (1I11/DD/)')')'Y) ('1414/DD/15-11 AUTOMOBILE LIABILITY B CA 4806893 03/01/2015 06/01/2016 Combined $5,000,000 Commercial Auto (AOS) Single Limi B CA 4806894 03/01/2015 06/01/2016 Commercial Auto (MA) B CA 4806895 03/01/2015 06/01/2016 Commercial Auto (VA) WORKERS COMPENSATION C N/A wc021569600 03/01/2016 06/01/2016 MA, ND, WI, WY C N/A wc021569597 03/01/2016 06/01/2016 FL C N/A wc021569599 03/01/2016 06/01/2016 IL, KY, NC, NH, UT C N/A wC021569601 1 06/01/2016 AK, AZ, GA C N/A wC021569598 03/01/2016 06/01/2016 NJ, PA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD