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HomeMy WebLinkAboutInsurance Certificate: Univar Inc (5) F DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/31/2018 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 2D 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 Philadelphia PA Office (A/C. No. Ext): (866) 283-7122 800-363-0105 One Liberty Place E-MAIL p 1650 Market street ADDRESS: _ suite 1000 Philadelphia 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 suite 200 INSURER C: ACE Fire underwriters Insurance Co. 20702 Downers Grove IL 60515 USA INSURER D: Illinois union insurance Company 27960 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570071445307 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 SR TYPE OF INSURANCE ADD U POLICY NUMBER POLICY F P LI Y EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY XSLG71 4 1 1 -LEACH OCCURRENCE $3,000,000 CLAIMS-MADE SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000 X❑ OCCUR PREMISES Ea occurrence MED EXP (Any one person) EXCI tided PERSONAL B ADV INJURY $3,000,000 p GEN'LAGGREGATE LIMITAPPLIES PER GENERALAGGREGATE $3,000,000 LE X POLICY F-] PRO- ❑ LOC PRODUCTS - COMP/OPAGG $3,000,000 o OTHER o r` A AUTOMOBILE LIABILITY ISAH25158295 06/01/2018 06/01/2019 COMBINED SINGLE LIMIT $5,000,000 Commercial Auto Ea accident BODILY INJURY ( Per person) O X ANYAUTO Z OWNED SCHEDULED BODILY INJURY (Per accident) N AUTOS ONLY AUTOS iE HIREDAUTOS NON-OWNED PROPERTY DAMAGE V Per accident ONLY AUTOS ONLY t d D X UMBRELLA LIAB X OCCUR XCEG27380566005 06/01/2018 06/01/2019 EACH OCCURRENCE $4,000,000 L) EXCESS LIAB CLAIMS-MADE SIR applies per policy terns & conditions AGGREGATE $4,000,000 DED X RETENTION B WORKERS COMPENSATION AND WLRC64787330 06/01/2018 06/01/2019 X SPER TATUTE OTH EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE YIN (AOS) E.L. EACH ACCIDENT $1 , 000 , 000 A OFFICER/MEMBER EXCLUDED? NIA WLRC64787378 06/01/2018 06/01/2019 (Mandatory in NH) (AZ, MA) E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under t 0 DESCRIPTION OF OPERATIONS below - E.L. DISEASE-POL Icy LI:-0f . $i , 00 ,000 ~i DESCRIPTION OF OPERATIONS / LOCATIONS / 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. ti. 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. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 MDl 8975Road IlLmir Ashland OR 97520 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC ACORO® _ _ ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Aon Risk Services Central, Inc. univar Inc. POLICY NUMBER see certificate Number: 570071445307 CARRIER NAIC CODE See Certificate Number: 570071445307 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 SUBR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSD WVD POLICYNLMBER LIMITS DATE DATE (MMIDDIYYY MMIDDAYYYY AUTOMOBILE LIABILITY A MMTH25158283 06/01/2018 06/01/2019 Combined $5,000,000 Truckers Liability single Limi WORKERS COMPENSATION A N/A wcuc64787494 06/01/2018 06/01/2019 (CA, OH, OR, WA) SIR applies per policy to ms & conditions C N/A SCFc64787457 06/01/2018 06/01/2019 (WI) ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD