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HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific DATE /YYYY) ACS CERTIFICATE OF LIABILITY INSURANCE 12/27 /2016 /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 CONTACT Marsh USA Inc. NAME: PHONE FAX 1717 Arch Street A/C No A/c No): Philadelphia, PA 19103-2797 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 424780-*ALL-GAW-17-18 INSURER A : Insurance Company Of The State Of PA 19429 INSURED INSURER B : ACE American Insurance Company 22667 BRENNTAG PACIFIC, INC. 10747 PATTERSON PLACE INSURER C : Indemnity Insurance Company of North America 43575 SANTA FE SPRINGS, CA 90670 INSURER D : Agri General Insurance Company 42757 INSURER E : ACE Fire Underwriters Co 20702 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-004767403-31 REVISION NUMBER: 12 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. INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY GL6538752 01/01/2017 01/01/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE a OCCUR DAMAGES ( RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 r - 1 JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY OTHER: $ B AUTOMOBILE LIABILITY ISAH09052446 01/01/2017 01/0112018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION WLRC49108242 (AOS) 01/0112017 01/0112018 X PER OTH- AND EMPLOYERS' LIABILITY Y /N ER B ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A WLRC4910828A (CA, MA) 01/01/2017 01/01/2018 E L. EACH ACCIDENT $ 2,000,000 D OFFICER/MEMBER EXCLUDED? (Mandatory in NH) WLRC49108321 (TN) 01/01/2017 01!01/2018 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E If yes, describe under SCFC49108369 (WI) 01/01/2017 01101/2018 DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below E.L. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: SUPPLYING CHEMICALS TO BOTH THE WATER TREATMENT PLANT LOCATED AT: 90 N. MOUNTAIN AVENUE, ASHLAND, OR 97520 AND THE WASTE WATER TREATMENT PLANT LOCATED AT 1195 OAK STREET, ASHLAND, OR 97520. THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION, WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND, OR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: KARI OLSON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 NORTH MOUNTAIN AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD