Loading...
HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc 7 ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 12/31/2020 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 I 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 Phone No.: (212)488-0200 CONTACT NAME: Laura Alvarez Fax No.: (212)488-0220 PHONE FAX EPIC Insurance Brokers&Consultants (A/c,No,Ext): 212A88.0427 IAIC.Not:212.488.0220 E-MAIL laura.alvarez[dapicbrokers.com 350 Hudson Street—4th Floor ADDRESS. New York, NY 10014 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 INSURER D: I PO Box 250 INSURER E: Riceboro GA 31323 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 TYPEOFINSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICYNUMBER IMMIDDIVYVYI IMMIDDIYYYY1 A x COMMERCIAL GENERAL LIABILITY Y IEPICB5ZFB001 12/31/2020 12/31/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PRDAMAGE EM SES(TEa occurrRENTEence) $500'000 MED EXP(Any one person) $25,000 I PERSONAL&ADV INJURY $1,000,000 1 GE '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 10ABR30602 12/31/2020 12/31/2021 COMBINED SINGLE LIMIT , $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED • SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ A UMBRELLA LIAB X OCCUR IEELCASB5ZFD001 12/31/2020 12/31/2021 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE _AGGREGATE $3,000,000 DED RETENTION$ $ C WORKERS COMPENSATION 1OWNR3O600 12/31/2020 12/31/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 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 I $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 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 I 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 .----_____e.-4.4c.-2,--3 .G'C.-C.LAG- iJ ©1988-2014 ACORD-CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD \11/\ V FRENKEL&COMPANY 350 HUDSON STREET 4TH FL E = NEW YORK NY 10014-4500 CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1850