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HomeMy WebLinkAboutInsurance Certificate: Suburban Propane L.P. ACORUEt DATE(MMIDDIYYYY) �..CP CERTIFICATE OF LIABILITY INSURANCE 09/18/2020 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: I PHFAX 445 SOUTH STREET INC.NNo.Extl: 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 INSURER B:LM Insurance Corporation 33600 SUBURBAN PROPANE L.P. 240 ROUTE 10 WEST INSURER C:Liberty Insurance Corporation 42404 PO BOX 206 WHIPPANY,NJ 07981 INSURER D 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR •INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY TB2-631-507975-080 10/01/2020 10/01/2021 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR PRPREMISES({ 250,000SRENTED Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT _ OTHER: $ A AUTOMOBILELIABILITY AS2-631-507975-070 10/01/2020 10/01/2021 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ X OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X ',HIRED X NON-OWNED . PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WA5-63D-507975-090 (AOS) 10/01/2020 10/01/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C YIN WA7-63D-507975-100 (MA) 10/01/2020 10/01/2021 E.L.EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE 1,000,000 B (Mandatory in EREXCLUDED? n N/A WC5-631-507975-110 10/01/2020 10/01/2021 (Mandatory in NH) ) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i i f DESCRIPTION OF OPERATIONS/LOCATIONS/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 HEREIN 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 20 EAST MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MukheI i .,rjee t,t1.e,�.rxe>t.,: .$yl.µto ede.. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I Dear Certificate Holder: As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To streamline delivery and in an effort to support our firm's commitment to sustainability„going forward,we would like to distribute your Certificates of Insurance electronically if possible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Please send your response to: USOperations.email@marsh.com and provide the following information so that we can expedite your COI delivery: • Certificate #(Shown below Insured Name—e.gJ:ABC- .23456789-01) • E-Mail for future delivery: For undeliverable email addresses,our system is configured to automatically redirect the Certificate for delivery via USPS. Lastly, if you no longer need this COI please respond to USOperations.emai€@marsh.corn with the Certificate number and we will inactive the record,in our system to avoid future automatic delivery. Thank you. US Operations, Marsh USA, Inc. 0003141 SP 0467 -C01-P03142-1 CITY OF ASHLAND 20 EAST MAIN STREET ASHLAND, OR 97520