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HomeMy WebLinkAboutInsurance Certificate: Andritz Separtation Nc. 05114/201 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM8 YY) 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 2 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 1 PRODUCER CONTACT NAME: ~ Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX 800-363-0105 m Philadelphia PA office (ac. No. Ext): (ac. No.): -o one Liberty Place E-MAIL o 1650 Market street ADDRESS: _ Suite 1000 Philadelphia PA 19103 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Mutual Fire 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: 570071141551 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 INSD WVD POLICY NUMBER MM/D1D/YYYY MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY TB 2 6 5 41 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE T RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 V X POLICY F-] PE F-] LOC PRODUCTS - COMP/OP AGG $2,000,000 0 OTHER: CD in A AUTOMOBILE LIABILITY As2-651-004304-037 06/01/2017 06/01/2018 COMBINED SINGLE LIMIT 11,000,000 Ea accident , X ANYAUTO BODILY INJURY ( Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) y AUTOS ONLY AUTOS i HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident w t 0) UMBRELLA LIAB HOCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WA765DO04304137 06/01/2017 06/01/2018 X STATUTE OTH EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N (AOS) E.L. EACH ACCIDENT $1,000,000 B OFFICER/MEMBEREXCLUDED' ~ NIA WC7651004304147 06/01/2017 06/01/2018 (Mandatory in NH) (wI) E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under - DESCRIPTION OF OPERATIONS Eel- E.L. DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon, and its elected officials, officers and employees are added as an Additional Insured on the coverages, excluding workers' Compensation and Employer's Liability policies, if required by written contract with Certificate Holder and subject to the policy terms, conditions and exclusions. General Liability and Automobile Liability policies evidenced herein are Primary and Non-Contributory to other insurance available to the Certificate Holder, but only to the extent required by written contract with the Insured and always subject to the policy terms, conditions and exclusions. ~y CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Ashland, Oregon AUTHORIZED REPRESENTATIVE V-11 20 East Main Street Ashland OR 97520 USA e~{LO~ i% e:ldG ~GGttee'!!D ~G~~y~L eJ ~l ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD