HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc.,4`CU? o�® CERTIFICATE 4F LIABILITY INSU °ATE113/°C
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI IN
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) 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 endorsementls).
EPIC Insurance Brokers & Consultants
1140 Avenue of the Americas — 8th Floor
New York, NY 10036
INSURED
Polydyne Inc.
One Chemical Plant Road
PO Box 250
Riceboro GA 31323
INSURERS] AFFORDING COVERAGE j NAlC #
INSURERA: IRONSHORE SPECIALTY INSURANCE COMPANY I 25445
INSURER B. HARTFORD FIRE INSURANCE COMPANY j 19682
INSURER C: HARTFORD ACCIDENT AND INDEMNITY COMPANY 22357
INSURER E:
INSURER F:
COVERAnPA r,= rrerrA-- >u ixm—. --- --__ --- -
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 PAfD CLAIMS.
INSR
LTR
TYPEOFENSURANCE
AODL-SUBRPOLI
INSD
WVD
POLICY NUMBER
PMID13"FF
EXP
-
LIMITS
A
'ix
COMMERcwLGENERALLIABILMY
OCCUR
Y
IEPICB5ZFB005
12/31/2024
umtnn[
12/31/2026
EACHOCCURRENCE
$1,000,0130
DAA`IAGO RTEDCLAJMS-MADE
our ane
$500,000-PREAEa
MED EXP (Anyone person)
$25,000
- .....
PERSONAL RADVINJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ PRO- ❑
JECT LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COIMP/OP AGO
$2,000,000
B
AUTOMOBILE
X
X
il--
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
H3REDAUTOS X NONOWNED
AUTOS
Y
1OA13R30602
12131Y2024
12/31/2025
COMBINED SINGLE LIMIT
Ea a
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PRbP1=RTYDAMAGE
Per erdderttl
$
$
I
A
IE X
UMBRELLA LIAB
EXCESSLlAB
X
OCCUR
CLAIMS -MADE
IEELCASB5ZFDO05
12/31/2024
12/31/2025
EACH OCCURRENCE
$3,000,000
AGGREGATE
$U)00,000
DED RETENTIONS
$
C ' WORKERS COMPENSATION
IANDEMPLOYERS'LIABILITY YIN
?F0PREETORfPARTNEWEXECUTNE
OFICE❑.
FFICERiR4Et..a£R Fa(CLUDED'I
(fyes.dorybeund
If yes, describe under
NIA
IOWNR30600
12/31/2024
12/31/2025
X OTH-
STRFR
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
'DESCRIPTION OFOPERATIONS Wow
—LL
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
The City of Ashland, its elected officials, officers 8 employees are included as Additional Insureds on the General Liability and Automobile Liability policies as required
by contract With respect 10 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 par terms and conditions of the policies.
RE: Polydyne Clarifioc C-6286 (LI quid Polymer)
30 DAY CANCELLATION CLAUSE INCLUDED
rr-w. r C nvr„ur-m (--A1u(`FI ! ATInM
City of Ashland
20 East Main Street
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
LV 1ytf5-[U14 AUOKD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD