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HomeMy WebLinkAboutInsurance Certificate: Univar Inc ~ DATE(MMIDD/YYYY) A~oR~ CERTIFICATE OF LIABILITY INSURANCE 05131!2017 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 -p NAME: Aon Risk Services Central, Inc. Phi 1 adel phi a PA office (a°.Nly . Ext): (866) 283-7122 ~~C Na 800-363-0105 One Liberty Place E-MAIL o 1650 Market Street ADDRESS: _ Suite 1000 Phi 1 adel phi a 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 INSURER C: Agrl General Insurance Company 42757 Suite 200 Downers Grove IL 60515 USA INSURER D: ACE Fire Underwriters Insurance Co. 20702 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 57006660913 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 R TYPE OF INSURANCE ADD UBR POLICY NUMBER P LI Y EFF POLICY EXP LIMITS LTR INSD WVD MMIDDlYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY XSLG J 1 1 17 1 1 EACH OCCURRENCE $ 3 , OOO , OOO SIR applies per policy ter s & COndl l Ons DAMAGE TO RENTED $1, OOO, OOO CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence MED EXP (Any one person) Excluded PERSONAL & ADV INJURY $ 3 , OOO , OOO ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3 , OOO , OOO X POLICY ❑ P~ ~ ❑ L.OC PRODUCTS - COMPlOP AGG $3 , OOO , OOO ~ 0 OTHER: ~ r` A AUTOMOBILE LIABILITY ISA H09059532 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT $5 , OOO, OOO ~ Commercial Auto Ea accident X ANY AUTO BODILY INJURY (Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) ~ AUTOS ONLY AUTOS PROPERTY DAMAGE ~ HIRED AUTOS NON-OWNED V ONLY AUTOS ONLY (Per accident) N UMBRELLALIAB OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC64409906 06/01/2017 06/01/2018 X STATUTE oRH EMPLOYERS' LIABILITY A ANY PROPRIETOR I PARTNER l EXECUTIVE YN N wARC64409918 06/01/2017 06/01/2018 E.L. EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDEDn ~ N ! A (Mandatory in NH) (AZ, MA) E.L. DISEASE-EA EMPLOYEE $1, OOO, OOO If yes, describe under G L nlcF OSE.oOI ir.Y LIMIT q+1 -000 , 000 DESGRIP i IuN Ur UrtKH iUNS below - -J DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Bid #2008-101 & Bid 2008-102, Superfloc N-300 LMW; Calcium Hypochlorite; Caustic Soda; Sodium Hypochlorite; 565; Location: W Portland. City of Ashland and all employees are included as Additional Insured on the General Liability and Automobile ~ - Liability Policies with respect to written contract. Univar is self-insured for physical damage to their vehicles. t• ~-i 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. W City of Ashland AUTHORIZED REPRESENTATIVE ~ Attn : Karl Olson yam",,," 90 N. Mountain Avenue Ashland oR 97520 USA ~ ~j'L,~ ~strzs~aed na e ©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 AC'C7RO~ ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER See Certificate Number: 570066609137 CARRIER NAIC CODE See Certificate Number: 570066609137 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 SL`BR EFFECTIVE EXPIRATION LTR TYPE OF INStiRANCE INSR WVD POLICY NUMBER DATE DATE LIMITS (MMlDDlYYYY (MMlDDlYYYY AUTOMOBILE LIABILITY A ISA H09059520 06/01/2017 06/01/2018 combined $5,000,000 Truckers Liability Single Limi WORKERS COMPENSATION A N/A wCUC64409943 06/01/2017 06/01/2018 (CA, OH, OR, WA) SIR applies per policy to ms & conditi ns D N/A scFC644o9931 06/01/2017 06/01/2018 (wI) ~ N/A wLRC6440992A 06/01/2017 06/01/2018 (TN) ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD