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HomeMy WebLinkAboutInsurance Certificat: Univar Inc A ® DATE(5 M/DUD,/YYYY) 0318 CERTIFICATE OF LIABILITY INSURANCE 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 (A C. No.): 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 INSURERA: 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: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570071445305 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 INSR LTR TYPE OF INSURANCE INADDL SUER SD WVD POLICY NUMBER D/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY XSLG71094637 mw l/201 06/01/2019 EACH OCCURRENCE $3,000,000 CLAIMS-MADE X❑OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) EXCi uded PERSONAL &ADV INJURY $3,000,000 p GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $3,000,OOO M 0 X POLICY ❑ PRO F-] LOC PRODUCTS - COMP/OP AGG $3,000,000 0 OTHER 0 A ISAH25158295 06/01/2018 06/01/2019 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY S5,000,000 commercial Auto Ea accident BODILY INJURY ( Per person) O X ANY AUTO Z OWNED SCHEDULED BODILY INJURY (Per accident) (D AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED V ONLY AUTOS ONLY Per accident w d UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC64787330 06/01/2018 06/01/2019 X STATUTE ORH EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE YIN (AOS) E.L. EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? N N/A WLRC64787378 06/01/2018 06/01/2019 E.L. DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) (AZ, MA) If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIME( 21 , VUU, ODU - DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 411-_ RE: Bid #2008-101 & Bid 2008-102, Superfloc N-300 LMW; Calcium Hypochlorite; caustic soda; Sodium Hypochlorite; SBS; Location: Qf, 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. ~-1 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 ~a 90 Mountain Avenue 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 A~RO® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Inc. POLICY NUMBER See certificate Number: 570071445305 CARRIER NAIC CODE See Certificate Number: 570071445305 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 St BR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE LNSD WVD POLICYNFMBER LIMITS DATE DATE (MM/DD/YYY'Y :NM/DD/YYYY AUTOMOBILE LIABILITY A MMTH25158283 06/01/2018 06/01/2019 Combined 55,000,000 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 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD