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HomeMy WebLinkAboutInsurance Certificate: Thermo Fluids Inc.Page 1 of 2 rY CERTIFICATE OF LIABILITY INSURANCE DATE 10/23/2024Y) 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 CONTACTWTW Certificate Center Willis Towers Watson Northeast, Inc. NAME: c/o 26 Century Blvd PHIC ONE 1-877-945-7378 'C o: 1-888-467-2378 P.O. Box 305191 A7[MR . certificates@wtwco.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC_k INSURERA: Starr Indemnity 6 Liability Company 38318 INSURED INSURERS: ACE American Insurance Company 22667 Thermo Fluids Inc. ----- 42 Longwater Drive INSURER C : Norwell, NA 02061 INSURERD: INSURER E : INSURER F : CAVERAGES CFRTIFICATF NIIURFR• W35789216 QCVI¢InN uNlaanro. 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 _---AODLSUBR',� ��-��- �- ��� �- -_-� -�-'-� POLICYEFF I POUCYEXP r ----_-__ ._ !— - --- -.. LTR POLICY NUMBER MM D/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000,000 CLAIMS -MADE X OCCUR I PREMISESTEa o rrenc $ 500, 000 A ._ ,- _- _ X 'XCU ; MED EXP (Any oneperson) $ 10,000 X Contractual Y 1000090736241 11/01/2024 11/01/2025 PERSONAL 8 ADV INJURY $ 2,000,000 $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ! GENERAL AGGREGATE PO X POLICY X JECT_ LOG PRODUCTS • COMP/OP AGG S 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _Ea agcidenti- $ 51000,000 _ $ X ', ANY AUTO BODILY INJURY (Per person) A X OWNED SCHEDULED YAUTOS 1000679502241 11/01/2024I11/01/2025; ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON OWNED X PROPERTY DAMAGE XiW ONLY AUTOS ONLY $ A XUMBRELLA LIAS X OCCUR EACHOCCURRENCE $ 10,000,000 $ 10,000,000 EXCESS UAB CLAIMS -MADE 1000095587241 11/01/2024 11/01/2025',AGGREGATE DED ! RETENTION$ $ WORKERS COMPENSATION E. STATUTE ERTH- AND EMPLOYROPRIEERSPART LFrYER/ Y / N $ 2,000,000 • ANVPROPRIETOR:'PARTNER/EXECU7IYE OFFICER/MEMBEREXCLUDED? No I NIA 1000005137 (ADS) 11/OS/2024 ; E.L. EACH ACCIDENT 11/Ol/2025 (Mandatory In NH) E.L. DISEASE EA EMPLOYEEI $ 2, 000,000 If yes. describe under DESCRIPTION OF OPERATIONS bebw E.L. DISEASE • POLICY LIMIT $ 2, 000, 000 A ,Workers Compensation 6 Empl Llab 100 0005140 11/01/2024 11/01/2025;9.1,. SACK ACCIDENT 1$2,000,000 (AR, AZ, LA, NJ, NY, NC, VT, CT)' E.L. DISEASE - EA ENP $2,000,000 .Per Statute'E.L. DISEASE-POL LWT'$2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Scope of work: All operations of the Named Insured Umbrella is follow form over the General Liability, Auto Liability, and Employer's Liability. SEE ATTACKED r`FRTIFICATF HOLDFR r`ANCFI I ATInN 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 Ashland AUTHORIZED REPRESENTATIVE Attention: City of Ashland 20 East Main Street 97520 �} Ashland, OR (01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD sa ID: 26611830 BATCH: 3672064 8526: 2 " of 4 AC RV® AGENCY CUSTOMER ID: LOC #: AnnITIONAI RFMaRKS _R _HFnt1LF AGENCY Willis Towers Watson Northeast, inc. POLICY NUMBER See Page 1 CARRIER See Page 1 NAMED INSURED Thermo Fluida Inc. 42 Longwater Drive Norwell, NA 02061 NAIC CODE See Page 1 EFFECTIVE DATE: Sae Page 1 Paqe 2 Of 2 AUUI I IUNAL IitMAKK, THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance City of Ashland, 20 E. Main St, Ashland OR 97520 is named as an Additional Insured for General Liability and Auto Liability as their interests may appear if required by written contract but only with respect to liability arising out of operations of the Named Insured. INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company NAIC#: 38318 POLICY NUMBER: 1000005138 (MA, FL) EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation E.L. EACH ACCIDENT $2,000,000 i Employers Liability E.L. DISEASE - EA EMP $2,000,000 Per Statute E.L. DISEASE-POL LMT $2,000,000 INSURER AFFORDING COVERAGE: Starr Indemnity i Liability Company NAIC#: 38318 POLICY NUMBER: 1000679513241 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 ADDITIONAL INSURED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Auto Liability (MA) CSL (Ea accident) $5,000,000 Any Auto, Owned Autos only, MCS-90 Hired Autos only, Non -owned Autos only INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: COO - G27416603 010 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Contractor's Pollution Liability Per Poll'n Condition $10,000,000 Aggregate Limit $10,000,000 SIR $250,000 INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: COO - G27416603 010 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Per Wrongful Act $10,000,000 Aggregate Limit $10,000,000 SIR $250,000 ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID:26611830 BATCH:3672064 CERT: W35789216 8526: 2 of 4 COMMERCIAL AUTO SICA-1024 06 21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION AMENDATORY ENDORSEMENT Policy Number: 1000679502231 Named Insured: Clean Harbors, Inc. Effective Date: 11 /1 /2024 This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. It is hereby agreed that SECTION 11— COVERED AUTOS LIABILITY COVERAGE A. Coverage, 1. Who Is An Insured of the Business Auto Coverage Form and Motor Carrier Coverage Form, and SECTION I — COVERED AUTOS COVERAGES, D. Covered Autos Liability Coverage, 2. Who Is An Insured of the Auto Dealers Coverage Form are amended to include the following: Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your use of a covered "auto". However, the insurance afforded only applies to the extent permitted by law, and will not exceed the lesser of: (1) The coverage and/or limits of this policy; or (2) The coverage and/or limits required by said contract or agreement. All other terms and conditions of this policy remain unchanged. SICA-1024 06 21 Copyright © Starr Indemnity & Liability Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 8526: 3 COMMERCIAL AUTO SICA-1024 06 21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION AMENDATORY ENDORSEMENT Policy Number: 1000679513241 Named Insured: Clean Harbors, Inc. Effective Date: 11/1/2024 This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. It is hereby agreed that SECTION II — COVERED AUTOS LIABILITY COVERAGE A. Coverage, 1. Who Is An Insured of the Business Auto Coverage Form and Motor Carrier Coverage Form, and SECTION I — COVERED AUTOS COVERAGES, D. Covered Autos Liability Coverage, 2. Who Is An Insured of the Auto Dealers Coverage Form are amended to include the following: Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your use of a covered "auto". However, the insurance afforded only applies to the extent permitted by law, and will not exceed the lesser of: (1) The coverage and/or limits of this policy; or (2) The coverage and/or limits required by said contract or agreement. All other terms and conditions of this policy remain unchanged. SIC A-1024 06 21 Copyright © Starr Indemnity & Liability Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 8526: 3 of 4 POLICY NUMBER: 1000090736241 COMMERCIAL GENERAL LIABILITY CG20261219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Where Required By Written Contract Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG20261219 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall applicable limits of insurance. © Insurance Services Office, Inc., 2012 not increase the Page 1 of 1 8526: 4