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HomeMy WebLinkAboutInsurance Certificate: Univar Solutions USA Inc. YYYY ...44C-4C)/2 ® DAT 0(MM/D202 ) 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. I IMPORTANT:If the certificate holder is an ADDITIONAL.INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.If, d 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). PRODUCERCONTACT 'p • Aon Risk Services Central, Inc. P ONE FAX Phi 1 adel phi a PA office (aC.No.Ext): (866) 283-7122 (A/C.No.): 800-363-0105 a One Liberty Place E-MAIL 1650 Market Street ADDRESS: Suite Philadelphia 00 ph Philaia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE American Insurance Company 22667 Univar Solutions USA Inc. INSURERS: Indemnity Insurance Co of North America 43575 3075 Highland Parkway Suite 200 INSURER C: ACE Fire underwriters Insurance Co. 20702 Downers Grove IL 60515 USA INSURER D: Illinois Union Insurance Company 27960 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570081934135 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 INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER •. (MM/DD/YYYY) MM/DD/YYYYv) LIMITS A X COMMERCIAL GENERAL LIABILITY xSLG71451732 06/01/2020 66/01/2021 EACH OCCURRENCE $3,000,000 SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) Excluded PERSONAL&ADV INJURY $3,000,000 m GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 F X POLICY 1—i PRO (�LOC PRODUCTS-COMP/OPAGG $3,000,000 rn /ECT I op 0 OTHER: r- A AUTOMOBILE LIABILITY ISA H25306582 06/01/2020 06/01/2021 COMBINED SINGLE LIMIT $5,000,000 mCommerci al Auto (Ea accident) .. X ANY AUTO BODILY INJURY(Per person) Z OWNED —SCHEDULED BODILY INJURY(Per accident) 0) AUTOS ONLY _AUTOS c0 HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY _AUTOS ONLY (Per accident) w t: 0) D X UMBRELLA LIAB X OCCUR XCEG27380566007 06/01/2020 06/01/2021 EACH OCCURRENCE $4,000,000 0 SIR applies per policy terns & conditions AGGREGATE $4,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION _ B WORKERS COMPENSATION AND WLRC67459180 06/01/2020 06/01/2021 X PER STATUTE OETTH- EMPLOYERS'LIABILITY A ANY PROPRIETOR OFFICER/MEMBER CRLTNER/UDED EXECUTIVE YN" AOS 1 N/A WLRC67459222 06/01/2020 06/01/2021 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) MA E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under EL DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS below a 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. .:1 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 Ashl and AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Road eijatut i a M Ashland OR 97520 usAuc+'._cO teeer.ffaa. MI ©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#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Univar Solutions USA Inc. POLICY NUMBER See.certificate Number: 570081934135 CARRIER See Certificate Number: 570081934135 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 SUER POLICY NUMBERLIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATIONE DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY A . MMT H25306624 06/01/2020 06/01/2021 Combined $5,000,000 Truckers Liability Single Li mi WORKERS COMPENSATION C N/A SCFC6745926A 06/01/2020 06/01/2021 WI A N/A wcuc67459301 06/01/2020 06/01/2021 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