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HomeMy WebLinkAboutInsurance Certificate: Univar Solutions USA Inc. �1 ® DATE(MM/DO/YYYY) �`�o CERTIFICATE OF LIABILITY INSURANCE 05/27/2021 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 al certificate does not confer rights to the certificate holder in lieu of such endorsement(s). C' PRODUCER CONTACT13 NAME: .AOn Risk Services Central, Inc. PHONEFAX w Philadelphia PA Office (A/c.No.Ext): 0866) 283-7122 (AIC.No.); 800-363-0105 13 One Liberty Place E-MAIL 6 1650 Market Street ADDRESS: -_ Suite Philadelphia ph Philaia PA 19103 USA INSURER(S)AFFORDING COVERAGE, NAIC# INSURED INSURER A: ACE American Insurance Company 22667 univar solutions USA Inc. • INSURER B: Indemnity Insurance Co of North America 43575 3075 Highland Parkway suite 200 INSURER C: ACE Fire Underwriters Insurance Co. 20702. Downers Grove IL 60515 USAINSURERD: Illinois Union Insurance Company,: 27960 INSURER E: INSURER F: ,. COVERAGES CERTIFICATE NUMBER:570087453516 • 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. Limits shown are as requested INSRA001.SUBR POLICY EFF- POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER . (MM/DD/YYY MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY XSLG72479634. 06/01/2021 06/01/2022 EACH OCCURRENCE $3,000,000 CLAIMS-MADE I !OCCUR SIR applies per policy terns & condi`-1 Ons DAMAGE TO RENTED $1,000,006 PREMISES(Ea occurrence) MED EXP(Any one person) Excluded PERSONAL&ADV INJURY $3,000,000 fD GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 in X I POLICY ❑JEC 1I LOC PRODUCTS-COMP/OP AGG $3,000,000 00 --{I o OTHER: A AUTOMOBILE LIABILITY ISA H25547998 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT $5,000,000 _ Commercial Auto (Ea accident) o BODILY INJURY(Per person) X ANY AUTO Z — OWNED —SCHEDULED BODILY INJURY(Per accident) y AUTOS ONLY — PROPERTY DAMAGE AUTOS - HIRED AUTOS NON-OWNED V ONLY _AUTOS ONLY (Per accident) ir: t 0 D X UMBRELLA LIAB X OCCUR XCEG27380566008 06/01/202106/01/2022 EACH OCCURRENCE $4,000,000 V — — SIR applies per policy terns & condi ions AGGREGATE $4,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION B WORKERS COMPENSATION AND WLRC67821464 06/01/2021 06/01/2022 X PER STATUTE OTH EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N AOS E.L.EACH ACCIDENT $1,000,000 ' A OFFICER/MEMBER EXCLUDED? N/A WLRC67821427 06/01/202106/01/2022 (Mandatory in NH) MA E.L.DISEASE-EA EMPLOYEE $1,000,000 DEsdRTriOOnFdOPERATIONS ERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— Ella 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. .-liFs--' • -.. 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. W '.• City of Ashland AUTHORIZED REPRESENTATIVE ,..r." ►'�t Attn: Kari Olson k. 90 N. Mountain Road �TIfile Ashland OR 97520 USA (� `�� �_ ll9f `�Z 1 Q y wg t 'Grla .cJ ?►ZRl�4 eJ 0 ©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: 570087453516 CARRIER NAIC CODE See Certificate Number: 570087453516 ' 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 NUMBERLIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) .(MM/DD/YYYY) AUTOMOBILE LIABILITY A MMT H25548036 06/01/2021 06/01/2022 combined 55,000,000 Truckers Liability Single Li mi WORKERS COMPENSATION . C N/A 5CFC67821506 06/01/2021 06/01/2022 WI A N/A WCUC67821385 06/01/2021 06/01/2022 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 logoare registered marks of ACORD