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HomeMy WebLinkAboutInsurance Certificate: Univar (2) OD DATE(MM/DD/YYYY) 06/01 /2016 ,4~C-O~R~ 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 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). PRODUCER CONTACT NAME: 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 E-MAIL o 1650 Market Street ADDRESS: _ 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 suite 200 INSURER C: Agri General Insurance Company 42757 Downers Grove IL 60515 USA INSURER D: ACE Fire Underwriters Insurance Co. 20702 INSURER E: Illinois Union Insurance Company 27960 INSURER F: COVERAGES CERTIFICATE NUMBER: 570062309874 REVISiGN 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 IN ADD BR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYW A X COMMERCIAL GENERAL LIABILITY HDOG 414A 1 1 0610112017 EACH OCCURRENCE $3,000,000 CLAIMS-MADE X❑ OCCUR SIR applies per policy terms & conditions DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) Excluded PERSONAL & ADV INJURY $3,000,000 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 0 X POLICY ❑ PE ❑ LOC PRODUCTS - COMP/OP AGG $3,000,000 Cl) OTHER: O r A AUTOMOBILE LIABILITY ISA H09043822 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT $5,000,000 Ln Commercial Auto Ea accident X ANY AUTO BODILY INJURY ( Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) Q AUTOS ONLY AUTOS *1 HIRED AUTOS NON-OWNED PROPERTY DAMAGE U (Per accident) ONLY AUTOS ONLY d U E X UMBRELLA LIAB X OCCUR XCEG27380566003 06/01/2016 06/01/2017 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE SIR applies per policy ter ins & conditions AGGREGATE $4,000,000 DED X RETENTION B WORKERS COMPEN ABIL ATION AND WLRC48608504 06/01/2016 06/01/2017 X SPER TATUTE OTH- EMPLOYERS' ANY PROPRIETOR / PARTNER / EXECUTIVE YIN (AOS) A OFFICER/MEMBER EXCLUDED? N/A WLRC48608498 06/01/2016 06/01/2017 E.L. EACH ACCIDENT $1,000,000 (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 - 3 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. - 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. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Road Ashland OR 97520 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC Page _ of _ ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER See certificate Number: 570062309874 CARRIER NAIC CODE see Certificate Number: 570062309874 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 ADDL SUBR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS DATE DATE MM/DD/YYYY (MM/DD/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