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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc 63, DATE(MM/DD/YYYY) ACCIREO CERTIFICATE OF LIABILITY INSURANCE 12/20/2021 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 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): 212.488.0427 (A/C.Nob:212.488.0270 E-MAIL laura.alvarezPenicbrokers.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: PO Box 250 Riceboro GA 31323 INSURER E: 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 TYPE OFINSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DDIVYYVb (MMIDDIVYYYI LIMITS A )( COMMERCIAL GENERAL LIABILITY Y IEPICB5ZFB002 12/31/2021 12/31/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $500,0017 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- $2,000,000$2,000,000 JECT LOC OTHER: $ B AUTOMOBILE LIABILITY Y 10ABR30602 12/31/2021 12/31/2022 COMBINED SINGLE LIMIT $1,000,000 X (Ea accident) ANY AUTO BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED accident BODILY INJURY AUTOS AUTOS (Per ) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ $ A UMBRELLA LIAB X OCCUR IEELCASB5ZFD002 12/31/2021 12/31/2022 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ C WORKERS COMPENSATION IOWNR30600 12/31/2021 12/31/2022 X SEl? OTH- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 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 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 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 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 fy,ftt2i-�..0 ( Fes r' c_.Cr1,t7 .� ©1988-2014 ACORD-CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD