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HomeMy WebLinkAboutInsurance Certificate: Suburban Propane ACO CERTIFICATE OF LIABILITY INSURANCE F D09/23/2019D/YYYY) L.. 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: 445 SOUTH STREET PIA/ON o t : A/C No : MORRISTOWN, NJ 07960-6454 E-MAIL Attn: Morristown.CertRequest@marsh.com Fax: 212.948.0979 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A : Liberty Mutual Fire Insurance Company 23035 INSURED 33600 SUBURBAN PROPANE L.P. INSURER B : LM Insurance Corporation 240 ROUTE 10 WEST INSURER C : Liberty Insurance Corporation 42404 PO Box 206 INSURER D : WHIPPANY, NJ 07981 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-010267283-07 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. POLICY EFF POLICY EXP INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MM/ D/YYYY MM LTR /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB2-631-507975-089 10/01/2019 10/01/2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE ~ OCCUR PREMISES (E. occurrence) r$ 250,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY F-1 PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER. $ A AUTOMOBILE LIABILITY AS2-631-507975-079 10/01/2019 10101/2020 COMBINED SINGLE LIMIT $ 2,000,000 Ea 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 _ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ $ B WORKERS COMPENSATION WA5-63D-507975-099 (AOS) IUMMUF-7/01/2020 X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER C Y I N WA7-63D 507975 109 (MA) 10/01/2019 10/0112020 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? NIA WC5-631-507975-119 (WI) I) 10/01/2019 10/01/2020 1,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ ,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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 HEREII 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 S+t m~,cca.~a►u ~+a+x tc.~.au. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD l