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HomeMy WebLinkAboutInsurance Certificate: Andritz Separation Inc A~~ ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0512612017 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). CONTACT ~ PRODUCER ~ NAME: Aon Risk Services Central, InC. PHONE FAX L Phi 1 adel phi a PA Office (AIC. No. Ext): (866) 283-7122 (wc. No.): 800-363-0105 ~ one Liberty Place E-MAIL o 1650 Market Street ADDRESS: _ Su-i to 1000 Phi 1 adel phi a PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURER A: L1 betty MUtUaI Fl re 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: 57UU66547736 REVISION NUMIBEk: 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 R ADD UBR P LI Y EFF POLI Y EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB 51 4 41 7 1 17 1 1 EACH OCCURRENCE $1, OOO, OOO CLAIMS-MADE X❑ OCCUR DAMAGE TO RENTED $1, OOO, OOO PREMISES Ea occurrence MED EXP (Any one person) $ 5 , OOO PERSONAL & ADV INJURY $1, OOO , OOO ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1, OOO , OOO ~ X POLICY ❑ JE ~ ~ LOC PRODUCTS - COMPIOP AGG $1, OOO , OOO ~ 0 OTHER. o r A AUTOMOBILE LIABILITY A52-651-004304-037 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT $1, OOO, OOO ~ Ea accident X ANY AUTO BODILY INJURY (Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) ~ AUTOS ONLY AUTOS ~ HIRED AUTOS NON-OWNED PROPERTY DAMAGE ~ ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WA765D004304137 06/01/2017 06/01/2018 X STATUTE ~RH EMPLOYERS' LIABILITY ANY PROPRIETOR I PARTNER I EXECUTIVE Y! N (AOS) E.L. EACH ACCIDENT $1, OOO , OOO B OFFICER/MEMBER EXCLUDED? ~ N IA WC7651004304147 06/01/2017 06/01/2018 (Mandatory in NH) (WI) E.L. DISEASE-EA EMPLOYEE $1, OOO, OOO If yes, descr((i~b~e under DLV V~I~TIV"~ CF 01'cR,gTlO^:C be!.^.'J.` E L DISEASE-POLICY LIMIT $1, OOO, OOO - =J DESCRIPTION OF OPERATIONS I LOCATIONS I 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 W 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. • CERTIFICATE HOLDER CANCELLATION 4..: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ci ty of Ashland AUTHORIZED REPRESENTATIVE ~~.-1 20 East Main Street s:.~ Ashland OR 76001 USA LY ~ i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD