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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc 0 DATE (MMIDDIYYYY) ,4~CORt>► CERTIFICATE OF LIABILITY INSURANCE 12/23/2016 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 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 Phone No.: (212) 488-0200 CONTACT NAME: _ Fax No.: (212) 488-0220 PHONE FAX Frenkel & Company a MA Lo..EXt): _ (A/C, No): 350 Hudson Street - 4th Floor ADDRESS____ New York, NY 10014 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AIG SPECIALTY INSURANCE COMPANY 26883_ INSURED INSURER B: COMMERCE & INDUSTRY INSURANCE COMPANY 19410 PolYdYne Inc. INSURER C: HARTFORD INSURANCE COMPANY OF THE MIDWEST 37478 One Chemical Plant Road INSURER D: _ PO Box 250 Riceboro GA 31323 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ADDL UBR LTR POLICY EFF POLICY EXP LIMITS INSR TYPE OFINSURANCE POLICY NUMBER INSD WVD A X I COMMERCIAL GENERAL LIABILITY X EG14362834 12/31/2016 12/31/2017 EACH OCCURRENCE A _ CLAIMS-MADE `X( OCCUR PREMISES (Ea occurrence) MED EXP (Any one person) $25,000 PERSONAL & ADV INJURY L000 0 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $2,000,000 POLICY PRO- PRODUCTS - COMP/OP AGG OTHER: X JECT LOC $2,000,000 $ B AUTOMOBILE LIABILITY X CA4691818 1 12/31/2016 12/31/2017 COMBINED I LIMIT accident) (Ea $1,000.000 X I ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ A UMBRELLA LIAB X OCCUR X EGU18403155 12/31/2016 12/31/2017 EACH OCCURRENCE 5; 1,000 490 X ! EXCESS LIAB CLAIMS-MADE AGGREGATE 1 000,000 DED RETENTIONS PER _ C WORKERS COMPENSATION 1OWNR30600 12/31/2016 12/31/2017 X S TATUTE EERH AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT ANY PROPRIETORPARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes. describe under DES(',RiPT(oN Ui= OPE,RuTiONS beh-)w DISEASE - POLICY L!M!T i DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland is included as Additional Insured under General Liability, Automobile Liability and Excess/Umbrella Liability coverage as required by contract with respect to liability arising out of the operations of the Named Insured, as their interest may appear, and subject to the policy terms conditions and exclusions. Coverage applies on a primary and non-contributory basis as required by contract and subject to the policy terms conditions and exclusions. RE: Polymer - Clarifloc C-6286 30 DAY CANCELLATION CLAUSE INCLUDED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISION Ashland, OR 97420 AUTHORIZED REPRESENTATIVE z7 4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks ofACORD