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HomeMy WebLinkAboutInsurance Certificate: Univar Solutions USA Inc • • `..� ® • DAT ( M Y AC DCERTIFICATE OF LIABILITYINSURANC€ 05/31/2022 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 °t certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'O NAME: Aon Risk Services Central, Inc. PHONE ( Philadelphia PA Office - (A/C.No.Ext)r (866) 283=7122 (A/C.No.). 800-363-0105 - 'a 100 North 18th Street . E-MAIL c 15th Floor - ADDRESS: _ Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE - NAIC# INSURED 'INSURER A: ACE American Insurance Company . 22667 Univar, Solutions'USA Inc. - . . INSURER B: ACE Fire underwriters Insurance-Co. 20702 - 3075 Highland Parkway suite 200 INSURER C: Indemnity Insurance Co of North America-43575 Downers Grove IL 60515 USA . . - INSURER D: Illinois Union Insurance Company 27960- INSURER E: _ - INSURER F: . COVERAGES CERTIFICATE NUMBER: 570093370136 REVISION NUMBER: 0r 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. - ADDL SUER - POLICY-EFF - POLICY EXP LTR _ TYPE OF INSURANCE. INSD'WVD - POLICY NUMBER (MM/DD/YYYY) I1MM/DD/YYYY - LIMITS • ,A X COMMERCIAL GENERAL LIABILITY XSLG47304775,. • 06/01/2022 06/O1/2023 EACH OCCURRENCE $3,000,000 'SIR applies• per policy.terns'&'conditions- - DAMAGE TOREN1ED CLAIMS-MADE 0 OCCUR PREMISES(Ea occurrence)- $3,000,000 • MED EXP(Any one person) Excluded PERSONAL&ADVINJURY $3,000,000 r�i GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3.,000 000 n X POLICY E PERT 0 LOC PRODUCTS-COMP/OP AGG $3,000,000' OTHER: a A ISA H10699058 06/01/2022 06/01/2023 COMBINED SINGLE LIMIT 'n Al1TOMOBILE LIABILITY $5,000,000 commercial Auto (Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 ' Z —SCHEDULED - BODILY INJURY(Peraccident)' d OWNED AUTOS , HIREDA — AUTOS ONLY - PROPERTY DAMAGE, .HIRED AUTOS NON-OWNED " • V (Per accident) ONLY _AUTOS ONLY d D X UMBRELLALIAB X OCCUR XCEG27380566009 -06/01/2022 06/01/2023 EACH OCCURRENCE $4,000,000 0 EXCESS LIAB CLAIMS-MADE SIR applies per policy terns & conditions AGGREGATE $4,000,000 DED -X RETENTION C WORKERS COMPENSATION AND WLRC70303085. - 06/01/2022 06/01/2023 X. PER STATUTE OTH- - EMPLOYERS'LIABILITY' Y/N AOS ER ANY PROPRIETOR/PARTNER/EXECUTIVE . E.L.EACH ACCIDENT $1,000,000 A OFFICER/MEMBEREXCLUDED? N/A wLRC70303048 06/01/2022 06/01/2023 - - - (Mandatory in NH) MA E,L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT,; "$1,000 000 INE DESCRIPTION.OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE: Contract to Supply water Treatment Chemicals, Ashland, City-of.Waste water Treatment Plant. " - - — 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 Q�..■_ POLICY PROVISIONS. r�L• City of Ashland AUTHORIZED REPRESENTATIVE= Attn: Kari Olson 90 N. Mountain Road i Ashland OR 97520 USA n/� McL149 ir�xe G s Oe/�aa eX Xara. n�G ©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#: ADDITIONAL . REMARKS SCHEDULE ,Page' _ of•. AGENCY NAMED INSURED Aon Risk services Central, Inc. Univar Solutions USA Inc. POLICY NUMBER See Certificate Number: 570093370136 . CARRIER NAIC CODE See Certificate Number: 570093370136 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. INSR POLICY POLICY ADDL SUBR. POLICY NUMBER, LIMITS LTR TYPE OF INSURANCE . INSD WVD EFFECTIVE EXPIRATION DATE DATE -. (MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY A MMT H10699125 06/01/2022 06/01/2023 combined S5,000,000 Truckers Liability Single Li mi WORKERS COMPENSATION s N/A SCFC70302962 06/01/2022 06/01/2023 WI A N/A wc1JC70303000. 06/01/2022 06/01/2023 Excess WC--CA OH OR,WA. SIR applies per. policy terms &'conditions ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved.. The ACORD name and logo are registered marks of ACORD, MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire,IL 60069 MDG2022 00002257 01 111111111111111111IItiII111111IIIiiu1111111,1111111111rillll4t1 IWA City of Ashland Attn: Kari Olson 90 N. Mountain Road Ashland OR 97520 r� Certificate No: 570093370136. ON City of Ashland • Attn: Kari Olson 90 N. Mountain Road Ashland OR 97520 USA Wednesday, June 1, 2022 • To whom it may concern:, Following a concentrated effort to reduce our environmental footprint and provide timely certificate delivery, Aon will begin delivering our Certificates of Insurance electronically in PDF format. Please utilize oneof the following methods to ensure you will receive the electronic copy of your Certificate (Certificate No: 570093370136) for future renewals: - Visit aon.com/e-cert; or Utilize the QR Code below toenter/validate your information.: If your email address has changed or will be changing in the future, or you no longer require this certificate,please let us know using one of themethods above. Thankou for your cooperation and willingness to help us reduce our impact to the environment. . Y MSC# 17755 I Aon P.O. Box 1447 Lincolnshire, IL 60069 • • ■ ® s■ . ■