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HomeMy WebLinkAboutInsurance Certificate: Andritz Separation Inc DATE(MM/DD/YYYY) .4~o,RlJ CERTIFICATE OF LIABILITY INSURANCE 05/27/2016 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. L 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). c PRODUCER CONTACT d NAME: Aon Risk services Central, Inc. Philadelphia PA Office (a~N No. Ext): 0866) 283-7122 (Aic No.): 800-363-0105 one Liberty Place E-MAIL p 1650 Market Street ADDRESS: _ suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Mutual Fire Ins CO 23035 AndritZ Separation Inc. INSURER B: Liberty Insurance Corporation 42404 1010 Commercial Blvd., South Arlington TX 76001 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570062241152 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 IN SR TYPE OF INSURANCE ADD UBR POLICY NUMBER P LICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY TB2651004304106 1 1 06/01/201/ EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑ OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $5,000 C\J PERSONAL & ADV INJURY $1, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000 ~ X POLICY ❑ PE ❑ LOC PRODUCTS - COMP/OP AGG $1,000,000 N 0 OTHER 0 r u~ A AUTOMOBILE LIABILITY AS2-651-004304-036 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY ( Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) r AUTOS ONLY AUTOS cC NON-OWNED PROPERTY DAMAGE t) HIRED AUTOS ONLY AUTOS ONLY (Per accident) N UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WA765DO04304136 06/01/2016 06/01/2017 X STATUTE FORTH EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE Y / N ( E.L. EACH ACCIDENT $1,000,000 B OFFICER/MEMBER EXCLUDED? N/A WC76 7651004304146 06/01/2016 06/01/2017 (Mandatory in NH) (WI) E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under DFSCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1 , 000 , 000 - 5t J DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ASI Project 1195. The City of Ashland, Oregon and its elected officials, officers and employees are included as i Additional Insured on the General Liability and Automobile Liability policies, if required by written contract with certificate Holder and subject to the policy terms, conditions and exclusions. El 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. City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main Street Ashland OR 76001 USA ~xr¢n ~,_'s a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD