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HomeMy WebLinkAboutInsurance Certificate: Univar Solutions USA Inc DATE(MM/DD/YYYY) G'ORL7. 05/31/2023 �- CERTIFICATE OF LIABILITY INSURANCE :� ' 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 termsand conditions of the policy,certainpolicies may require an endorsement.A statementon this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER CONTACT . NAME: - - Aon Risk Services central, Inc. . nPHONE (866) 283-7122 FAX 800-363-0105 `y. Philadelphia PA Office - (A/C.No.Ext): (A/C.No.): , .fl 100 North 18th street E-MAILp. 15th Floor - ADDRESS:, - Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIL 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 0: . Illinois union Insurance Company 27960 INSURER'S; INSURER F:. r COVERAGES, • CERTIFICATE NUMBER:570099676628 REVISION NUMBER: .��•'• w. 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.CONbITION 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/YYY (MM/DD/YYYY) ' " • LIMITS , A X COMMERCIAL GENERAL LIABILITY- , XSLG47313600 ' 06/01/2023 06/01/2024 EACH OCCURRENCE '. $3,000,000 SIR applies per policy'terns & conditions DAMAGE TO RENTED CLAIMS•MADE. X OCCURPREMISES(Ea occurrence) $3,000,000 , MED EXP(Any one person) Excluded • 'PERSONAL&ADV INJURY $3,000,000 N GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 n X POLICY El 111 JECT LOC,. PRODUCTS-COMP/OP AGG $3,000,000 - rn o• OTHER: • n .. A AUTOMOBILE LIABILITY ISA H10708436 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT $5,000,000 LO commercial Auto ' (Ea accident) ,• • X ANY AUTO BODILY INJURY(Per person) - O Z.. OWNED SCHEDULED BODILY INJURY(Per accident) `- al — AUTOS ONLY AUTOS ' tq HIRED AUTOS NON-OWNED. PROPERTY DAMAGE V ONLY _AUTOS ONLY (Per accident) w D X UMBRELLALIAB X OCCUR XCEG27380566010 06/01/2023 06/01/2024 EACH OCCURRENCE $4,000,000 V EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$5,000,000 C WORKERS COMPENSATION AND WLRC70313443, 06/01/2023 06/01/2024 x PER STATUTE 0TH- EMPLOYERS'LIABILITY Y/N AOS ER f3 ANY PROPRIETOR!PARTNER!EXECUTIVE El.EACH ACCIDENT. '$1,000,000 - OFFICER/MEMBEREXCLUDED? n N/A SCFC70313327' 06/01/2023 06/01/2024 - (Mandatory in NH) - WI E.L.DISEASE-EA EMPLOYEE' - •$1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT • '$1,000,000—, .. - • , Ell DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if morespaceis required)- +� RE: . Contract to Supply water Treatment Chemicals, Ashland', City',of Wastewater 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 ' POLICY PROVISIONS. „-,..•', City of Ashland AUTHORIZED REPRESENTATIVE tL y. Attn: Karr Olson 90 N. Mountain Road Ashl and OR 97520 USA eY�an/Jac9 ti `y i et e/ /1111" ' ©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 ACO LOC#: ADDITIONAL REMARKS SCHEDULE Page of _. AGENCY NAMED INSURED Aon Risk Services Central, Inc'. univar solutions USA " Inc. POLICY NUMBER see Certificate Number: '570099676628.. CARRIER NAIL CODE see certificate Number: 570099676628 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA 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. . POLICY POLICY INSR . ADDL SUBR POLICY NUMBERLIMITS LTR TYPE OF INSURANCE ' INSD WVD EFFECTIVE EXPIRATION DATE . DATE (MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY. A MMT N10708540 06/01/2023 06/01/2024 Combined $5,000,000 Truckers. Liability Single Limi, WORKERS COMPENSATION A . N/A. wcuc70313364 06/01/2023 06/01/2024 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 MDG2023.00002516 01 .11111 IIIllhrarIrn111111uuam.11111iIIi"IIilnriuhh City of Ashland Attn: Kari Olson. 90 N. Mountain Road Ashland OR 97520 • 0,1 • • Certificate No: 570099676628 ON City of Ashland Attn: Kari Olson 90 N. Mountain Road Ashland OR 97520 USA Thursday, June 1, 2023 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 one of the following methods to ensure you will receive the electronic copy of your Certificate (Certificate No: 570099676628)for future renewals. - Visit aon.com/e-cert; or - Utilize the QR Code below to enter/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 the methods above. Thank you for your cooperation and willingness to help us reduce our impact to the environment. MSC# 177551 Aon P.O. Box 1447 Lincolnshire, IL 60069 ■ c • ■ • .r 131 : ■