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HomeMy WebLinkAboutInsurance Certificate: Univar Inc (2) F L IAB I L I TY I N S U RAN C E DATE(MM1DD(YYYY) A~ CERTIFICATE 0 05/31(2017 THIS GFRTIFICATE 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 '6 PRODUCER NAME: ~ ADn Risk Services Central, Inc. PHONE (g66) 283-7122 F'~ 800-363-0105 m Phi 1 adel phi a PA office (AIC. No. Ext): (AIC. No.): ~p One Liberty Place E-MAIL ~ 1650 Market Street ADDRESS: _ Suite 1000 INSURER(S) AFFORDING COVERAGE NAIC # Philadelphia PA 19103 USA INSURED INSURER A. ACE American Insurance Company 22667 Univar Inc. INSURER B: Indemnity Insurance Co of North America 43575 3075 Highland Parkway INSURERC: Agri General Insurance Company 42757 Suite 200 Downers Grove IL. 60515 USA INSURER D: ACE Fire Underwriters Insurance Co. 20702 INSURER E: Illin015 Union Insurance Company 27960 INSURER F: COVERAGES CERlIFIl;A1E NUMt3ER: 57uu6bbuy~i~5 KEVjiuiv nUmistK: 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 areas requested INSR ADD U R POLI Y EF P LI Y EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY XSLG 7 1 1 7 1 1 EACH OCCURRENCE $ 3 , OOO , OOO SIR applies per policy ter S & COndl l On5 DAMAGE TO RENTED $1, OOO , OOO CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence' MED EXP (Any one person) EXCI uded PERSONAL & ADV INJURY' $3 , OOO , 000 ~ GENERAL AGGREGATE $3,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER' ~ X POLICY ❑ PRO ❑ LOC PRODUCTS - COMPIOP AGG $ 3 , OOO , OOO JECT a OTHER: i~ A AUTOMOBILE LIABILITY ISA H09059532 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT $5, OOO, OOO Ea accident _ Commercial Auto BODILY INJURY (Per person) ~ X ANY AUTO Z OWNED SCHEDULED BODILY INJURI' (Per accident) ~ AUTOS ONLY AUTOS PROPERTY DAMAGE ~ V HIRED AUTOS NON-OWNED (Per accident) ONLY AUTOS ONLY E XCEG27380566004 06/01/2017 06/01/2018 EACH OCCURRENCE $4, 000, 000 U X UMBRELLA LIAB X OCCUR SIR applies per policy ter s & condi ions AGGREGATE $4,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION B WORKERS COMPENSATION AND wLRC64409906 06/01/2017 06/01/2018 X STATUTE ~RH EMPLOYERS' LIABILITY Y 1 N (AOS E.L. EACH ACCIDENT $1, OOO , 000 ANYPROPRIETORlPARTNERIEXECUTIVE ~ wLRC64409918 06/01/2017 06/01/2018 A OFFICER/MEMBER EXCLUDED? N 1 A E.L. DISEASE-EA EMPLOYEE $1, OOO , 000 (Mandatory in NH) (AZ, MA) If yes, describe under E.L. DISEASE-POLICY LIMIT $1, OOO , OOO r1CC/'RIDTI(1~I r1C !1RFRATIINC hcln?y =J DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ~ RE: Contract to Supply water Treatment Chemicals, Ashland, City of waste water Treatment Plant. r- i.l ~H 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. ■ IIIL~- Ci ty Of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Road ~i Ashland OR 97520 USA eJno ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID; 570000014538 A~ ° ADDITIONAL REMARKS SCHEDULE Pa e _ of _ 9 AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER See Certificate Number: 570066609135 CARRIER NAIC CODE See Certificate Number: 570066609135 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. INSR ADDL SUBR POLICY POLICY TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS LTR INSD WVD DATE DATE (MM(DD/YYYY (MMlDD/YYYY 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 SCFC64409931 06/01/2017 06/01/2018 (WI) C 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