HomeMy WebLinkAboutInsurance Certificate: Northstar Chemical Inc.
124448
AC"Rb® DATE (MM/DDIYYYY)
lV, CERTIFICATE OF LIABILITY INSURANCE 6/27/2018
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).
CONTACT
PRODUCER
NAME:
Commercial Lines - (628) 201-9001 PHONE FAX
(A/c -o ExtJ, 628.201.9001 ac No : 610.537.2393
USI Insurance Services National, Inc. - CA Lic#: OD08408 nDORIESS: certificateswf@usi.com
201 Mission St, 11th Floor INSURER(S) AFFORDING COVERAGE NAIC 4
San Francisco, CA 94105 INSURERA: Aspen Specialty Insurance Cc 10717
INSURED INSURER B: XL Specialty Insurance Company 37885
Northstar Chemical Inc. INSURER C : SAIF Corporation 36196
14200 S.W. Tualatin-Sherwood Rd. INSURER D:
-INSURER E : _
Sherwood, OR 97140 INSURER F :
COVERAGES CERTIFICATE NUMBER: 13231781 REVISION NUMBER: See below
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 ADDLSUBR POLICY EFF POLICY EXP LIMITS
LTR IN SD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY
A X COMMERCIAL GENERAL LIABILITY ERAEJRW18 07/01/2018 07/01/2019 EACH OCCURRENCE S 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE 1 OCCUR PREMISES Ea occurrence S 300,000
X Pollution Included (Claims Made) MED EXP (Any one person) $ 25,000
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
POLICY FX IRI- F J LOC PRODUCTS - COMP/OP AGG S 2,000,000
OTHER $
B AUTOMOBILE LIABILITY AE00050135-01 07/01/2018 07/01/2019 E. cccideOISINGLE LIMIT $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) s
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per 1) 1
x MCS 90 x $5,000 Ded S
A UMBRELLALIAB X OCCUR EXAEJRX18 07/01/2018 07/01/2019 EACH OCCURRENCE S 5,000,000
1 EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000
DED RETENTIONS S
C WORKERS COMPENSATION 976980 07/01/2018 07/0112019 x STFIR ATUTE OTH
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER'EXECUTIVE YIN OREGON E.L. EACH ACCIDENT S
OFFICERIMEMBEREXCLUDED? 1:1 N/A 1,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEES S 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Evidence of Coverage
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland, OR 97520
AUTHORIZED REPRESENTATIVE
1( % r~4
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