HomeMy WebLinkAboutInsurance Certificate: Suburban Propane L.P.
a DATE (MM/DD/YYYY)
AoCt eCl CERTIFICATE OF LIABILITY INSURANCE F04/10/2018
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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
MARSH USA, INC. NAME` _
PHONE FAX
445 SOUTH STREET (A/C No. Exti: A/C No :
MORRISTOWN, NJ 07960-6454 E-MAIL
Attn: Morristown.CertRequest@marsh.com Fax: 212.948.0979 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
INSURER A : ACE American Insurance Company 22667
INSURED SUBURBAN PROPANE L.P. INSURER B : Indemnity Insurance Company of North America 43575
-
240 ROUTE 10 WEST INSURER C : ACE Fire Underwriters Insurance Company 20702
WHIPPANY, NJ 07981 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: NYC-010267283-01 REVISION NUMBER: 1
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.
INSR TYPE OF INSURANCE INSD SUWVD ER POLICY NUMBER MM DI
LTR D YYYY MM DD YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY HDO G27872608 10/01/2017 10/01/2018 EACH OCCURRENCE $ 2,000,000
DAMAGE TO RE
CLAIMS-MADE ~ OCCUR PREMISES Ea occurrence $ 250,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
POLICY F] PRO PRO El LOC PRODUCTS - COMP/OP AGG $ 2,000,000
X
T
OTHER $
A AUTOMOBILE LIABILITY ISA H09063572 1010112017 10/01/2018 COMBINED SINGLE LIMIT $
Ea 2,000,000
accident
X ANY AUTO BODILY INJURY (Per person) $
X OWNED X SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
B WORKERS COMPENSATION WLR 064622079 (AOS) 10/0112018 X STATUTE OERH _
AND EMPLOYERS' LIABILITY ( ) 1 000'000
A Y / N WLR 064622110 CA, MA, AZ 1010112017 10/0112018
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
C OFFICER/MEMBEREXCLUI N❑ N/A
SCF 064622158 10/0112017 1010112018
(Mandatory in NH) (WI) E1 . DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
THE CITY OF ASHLAND, OREGON, ITS OFFICERS, AGENTS AND EMPLOYEES ARE LISTED AS ADDITIONAL INSURED SOLELY WITH RESPECT TO GENERAL LIABILITY COVERAGE AS SHOWN HEREIN
AND SOLELY IN THE EVENT THIS STATUS IS REQUIRED BY WRITTEN CONTRACT BETWEEN SUBURBAN PROPANE LP OR ITS SUBSIDIARIES OR AFFILIATES AND CERTIFICATE HOLDER AND ONLY
WITH RESPECT TO SUBURBAN PROPANE'S SOLE NEGLIGENCE
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee _Ikf ta~.n ooc. ~d u terra c c-
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