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HomeMy WebLinkAboutInsurance Certificate: Andritz Separation Inc..aco CERTIFICATE OF LIABILITY INSURANCE FDATE/YYYY) �� o5/z9/2024s/zoz4 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, LLC. NAME: TWO ALLIANCE CENTER IPHONE FAX 3560 LENOX ROAD, SUITE 2400 EaMAI�o, Ext): (A/C, No): ATLANTA, GA 30326 ADDRESS: INSURED Andritz Separation Inc. 1010 Commercial Blvd. South Arlington, TX 76001 INSURER A: INSURER C : INSURER E : COVERAGE COVERAGES CFRTIFICOTF NI IMRFR• AT] _nncTca)n) M RFVICIt%KI Kit 111ARC0- n NAIC # 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 POLICY EFF LTR POLICY EXP LIMITS POLICY NUMBER MM/DD/YYYY MM/DD/Y A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR TB2-651-004304-103 06/01/2024 11/01/2024 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT ❑ LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY AS2-651-004304-033 06/01/2024 11/01/2024 COEa accidentMBINED SINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ r HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WA7-65D-004304-133(ADS) WA7-65D-004304-284 (MN) WC7-651-004304-143 (WI) 06/01/2024 06/01/2024 06/01/2024 11/01/2024 11/01/2024 11/01/2024 1 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may Ile attached if more space is required) General Liability policy includes Cross Liability/Severabiliry of Interest Clause. RE: Project Name: Goods and Services Agreement (Greater Than $35,000). The City of Ashland, Oregon, its officers, agents and employees are added as an Additional Insured with respect to the General Liability and Automobile Liability policies, if required by written contract with Certificate Holder and subject to the policy terms, conditions an exclusions. General Liability and Automobile Liability policies evidenced herein is Primary and Non -Contributory to other insurance available to the Certificate Holder, but only to the extent required by written contrac with the Insured and always subject to the policy terms, conditions and exclusions. rrl%,M I r- nvLvcl-I GANGELLA I IUN City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0005750 SP 0194-001-P05752-1 City of Ashland 20 East Main Street Ashland, OR 97520 0194-01-00-0005750-0001-0011861