Loading...
HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I 12/28/2 .v,; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. -IE4`• CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI a.'. ,- BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 Andrea Kim NAME: PHONE 212.293-6203 FAX EPIC Insurance Brokers&Consultants (A/C,No,Ext): 1A/C.Not:212_488.Q220 E-MAIL andrea.klmeepicbrokers.com 1140 Avenue of the Americas—8th Floor ADDRESS. New York, NY 10036 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: IRONSHORE SPECIALTY INSURANCE COMPANY 25445 INSURED INSURER B: HARTFORD FIRE INSURANCE COMPANY 19682 Polydyne Inc. INSURER C: HARTFORD ACCIDENT AND INDEMNITY COMPANY 22357 One Chemical Plant Road PO Box 250 INSURER D: Riceboro GA 31323 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER EXP IPOLIICY EFF YYYYI fMM/-f1DYYYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y IEPICB5ZFB003 12/31/2022 12/31/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $500,000 PREMISES(Ea occurrence) _ MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 10ABR30603 12/31/2022 12/31/2023 (EaMBcdeDSINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ A UMBRELLA LIAB X OCCUR IEELCASB5ZFD003 12/31/2022 12/31/2023 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTIONS $ C• WORKERS COMPENSATION 1OWNR30600 12/31/2022 12/31/2023 X PER H AND EMPLOYERS'LIABILITY YIN STATUTE ER • ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000. If yes,describe under DESCRIPTION OF OPERATIONS below 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,its elected officials,officers&employees are included as Additional Insureds on the General Liability and Automobile Liability policies as required by contract with respect to liability arising out of the operations of the Named Insured per terms and conditions of the above referenced policies. Insurance coverage applies on a primary and non-contributory basis as required by contract per terms and conditions of the policies. RE: Polydyne Clarifloc C-6286(Li quid Polymer) 30 DAY CANCELLATION CLAUSE INCLUDED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE 1 • • I 6 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD FRENKEL&COMPANY 350 HUDSON STREET 4TH FL NEW YORK NY 10014-4500 7. CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1849