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HomeMy WebLinkAboutInsurance Certificate: Univar A~ ® 06/01/2016 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 have ADDITIONAL INSURED provisions or 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). 73 PRODUCER CONTACT NAME: L Aon Risk services central, Inc. PHONE (866) 283-7122 FAX 800-363-0105 Philadelphia PA office (A/C. No. Ext): (A/C. No.): ,a) one Liberty Place -ADDRESS: _ 1650 Market Street Suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ACE American Insurance company 22667 Univar Inc. INSURER B: Indemnity Insurance Co of North America 43575 3075 Highland Parkway INSURER C: Agri General Insurance company 42757 suite 200 Downers Grove IL 60515 USA INSURER D: ACE Fire Underwriters Insurance Co. 20702 INSURER E: INSURER F: COVERAGES CERT iFiCAFE NUMBER: 570062308666 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 ILTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DDNYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY HDOG 4 4A h/01/201b EACH OCCURRENCE $3,000,000 SIR applies per policy ter ins & conditions DAMAGE TO RENTED $1,000,000 CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence MED EXP (Any one person) Excluded PERSONAL & ADV INJURY $3,000,000 0 cfl GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 ao ce) 000 X POLICY F-] PRO- F-] LOC PRODUCTS - COMP/OP AGG $3,000, JECT OTHER: 0 ISA H09043822 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT i° A AUTOMOBILE LIABILITY $5'000'000 Commercial Auto Ea accident BODILY INJURY ( Per person) C X ANY AUTO Z OWNED SCHEDULED BODILY INJURY (Per accident) r AUTOS ONLY AUTOS PROPERTY DAMAGE V HIRED AUTOS NON-OWNED Per accident ONLY AUTOS ONLY d UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48608504 06/01/2016 06/01/2017 X SPER TATUTE EORH EMPLOYERS' LIABILITY A ANY PROPRIETOR / PARTNER / EXECUTIVE YN WLRC48608498 06/01/2016 06/01/2017 E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) (MA) E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under - DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 H DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) t RE: Bid #2008-101 & Bid 2008-102, Superfloc N-300 LMW; Calcium Hypochlorite; Caustic Soda; Sodium Hypochlorite; SBS; Location: - - Portland. City of Ashland and all employees are included as Additional Insured on the General Liability and Automobile Liability Policies with respect to written contract. Univar is self-insured for physical damage to their vehicles. ti■ 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. Lai City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Avenue Ashland OR 97520 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER see certificate Number: 570062308666 CARRIER NAIC CODE See Certificate Number: 570062308666 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 INSURER 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS LTR INSD WVD DATE DATE MM/DD/YYYY (MMIDD/YYYY) AUTOMOBILE LIABILITY A ISA H09043834 06/01/2016 06/01/2017 Combined $5,000,000 Truckers Liability single Limi WORKERS COMPENSATION A N/A WCUC48608462 06/01/2016 06/01/2017 (CA, OH, OR, WA) SIR applies per policy to ms & conditions D N/A SCF8608474 106/01/2016 06/01/2017 (WI) C N/A WLRC48608486 06/01/2016 06/01/2017 (TN) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD