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HomeMy WebLinkAboutInsurance Certificate: Thermo Fluids Inc. Page l of 3 DATE(MMIDDNYYY) ACC> " CERTIFICATE OF LIABILITY INSURANCE 1Q/29/2028 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(ie-s)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 ri hts to the certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. clv 26 Century Blvd Pp ONNEo. . 1-877--945-7378 p e No: 1-888-467-2378 E-MAIL cert:Lf:Lcates@wtwco.com P.O. Box 305191 ADDRESS: @ Nashville, 7N 372305191 135A INSURERS AFFORDING COVERAGE I NAIL# iNSURERA: Starr Indemnity & Liability Company 38318 INSURED W INSURERS: Lloyd's I B7874 Thm%= Fluids Inc- 42 Longwater Drive INSURER C: ACZ AmericanInsurance Company 22657 Norvell, MA 02061 INSURER D: ENSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER:W41461554 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 REOUIREMENT,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. IN53i, TYPE OF INSURANCE A©DLiSUBR POLICY NUMBER MM DDlYY LICY P AM1DDrrYUCY YxYY I LIMITS LTR COM MERCIAL GENERAL LIABILITY I EACH OCCURRENCE is 2,000,000 i CLAIMS-MADE X OCCUR PREMISES Ea occurrence � $ 2,000,000 A X!XCU I MED EXP(Any one person) S 10,000 ;Contractual li 10 00 0 9073 6251 I'11/O1/2 025 1 11/01/202 6 1PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I.$ 4,000,000 i POLICY�� JE� J X j LOC PRODUCTS-COMP1OP AGG 15 4,000,000 i OTHER: I I$ AUTOM08[LELIASILITY COMBINED SINGLE LIMIT Is 5,G00,000 Ea accident ' ANY AUTO BODILY INJURY IPerperson) i$ A i OWNED i SCHEDULED y 10 00 67 950 22 51(AOS) 11/01/2025 11/01/2026 BOO ILYtNJURY{Peraccident I$ 1 AUTOS ONLY AUTOS I ) HIRED NON-OWNED PROPERT/DAMRGE $ '• &Iq7 ONLY I AUTOS ONLY ,der accident $ A X UMBREL ALIAS j XI OCCUR I 1000095587251 11/01/2025 11/01/2026 EACH OCCURRENCE Tj$ 14,000,000 EXCESS uAB GGRGACLS• DE 10,000,Op0 -DED SETEIITION$ 3 $ WORKERS COMPENSATION j E AND EMPLOYERS'LIABILITY ! 3 X STATUTE ERH A ,ANYPROPRIETORlPARTNERIEXECUT€VE YIN No E.L.EACH ACCIDENT $ 2,000,000 NlAi 1000005137(AOS) 11/01/2025 11/02/2026jJFFICERMEMBEREXCLUQEp? --- i(Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 2.000,000 R yes,describe under `DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT IS 2,000,000 13 Excess Business Auto Liability B080126749=5 11/01/2025 11/01/202SIPer Occurrence i$5,000,000 I I i `Aggregate I$10,000,000 I i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORDf 101,Additional Remarks Schedule,may be attached If more space is required) Scope of Work: 'Vacuum truck cleaning out oil water separators. Umbrella is follow form over the General Liability, Excess Auto Liability, and Employer's Liability. SEE ATTACFIEO CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Wes Boadley 9Q N. Mountain Ave. �tV. Ashland, OR 97520 S ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sa=. 28723631 BATCH: 4183453 30155: 2 of c AGENCY CUSTOMER ID: _ LOC#: AC40RV ADDITIONAL REMARKS SCHEDULE Page 3 Of 3 AGENCY NAMED INSURED Willis Tourers Watson Northeast, Inc. Thermo Fluids Inc- 42 Longwatar Drive POLICY NUMBER Norwell, M8 02061 See Page 1 CARRIER NAIC CODE See Page 1 Sep Page 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC$: 22667 POLICY NUMBER: COO G27416603 01l EFF DATE: 11/01/2025 EXP DATE: 11/01/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Contractor's Pollution Liability Per Poll'a 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 011 EFF DATE: 11/01/2025 EXP DATE: 11/01/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Per Wrongful Act $10,000,000 Aggregate Limit $lo,000,000 SIR $250,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID. 28723631 BATCE;4183453 CERT: W41461554 30155: 3 of 3 I 1 Page 1 of 3 ATE(MMID AFRO" CERTIFICATE OF LIABILITY INSURANCE FD10/29/2025Y) 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 WTW Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd AIC N P.O. Box 305191 ANNE..; certificates@wtwco.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC M INSURERA: Starr Indemnity a Liability Company 36318 INSURED INSURERB: Lloyd's 87874 Thermo Fluids Inc. -- 42 Longwater Drive INSURERC: ACE American Insurance Company _22667 Norwell, MA 02061 INSURER D: + _ INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:W41461553 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' AODL$Ua�'_ ._ ____ - -__ POLICY EFF j POLICY EXP LTR TYPE OF INSURANCE INSD Wyo POLICY NUMBER MM/DD/YYYY)i(MMIDDIYYYYI UMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 CLAIMS-MADE X j OCCUR PREMISES E occurrence $ 1,000,000 A X XCU 4---..—_.h._- Z MED EXP An one person) $ 10,000 X Contractual y 1000090736251 11/01/2025 11/01/2026 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE j $ 4,000,000 POLICY X jE X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: i$ AUTOMOBILE LIABILITY [BODILY OMBINED SINGLE LIMIT $ 5,000,000 Ea accident) _ X ANY AUTO INJURY(Per person) IS A OWNED SCHEDULED Y 1 000 67 95022 51(AOS) 11/01/2025;11/01/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE - ONLY ONLY AUTOS ONLYLPer $ _ A X UMBRELLAUAB X OCCUR EACH OCCURRENCE $ 10,000,000 _ -CLAIMSMADE EXCESS LIAB 1000095587251 11/01/2025 11/01/2026}AGGREGATE $ 10,000,000 i DED RETENTION$ $ WORKERS COMPENSATION X H- AND EMPLOYERS'LIABILRY STATUTE I i ER / 2,000,000_ OFICER/MEMBEREXCUDD N N/A 1000005137(AOS) 11/01/2025 11/01/2026 - - -A ?ECUTIVE E.L.E L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 It yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT !$ 2,000,000 B Excess Business Auto Liability 8080126749U25 11/01/2025 11/01/2028,Per Occurrence 1$5,000,000 ,Aggregate $10,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Scope of work: All operations of the Named Insured Umbrella is follow form over the General Liability, Excess Auto Liability, and Employer's Liability. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION 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 Ashland, OR 97520 t'��/ p• 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ot ID: 28723631 RATca: 4183453 30156: 2 of, i AGENCY CUSTOMER ID: LOC#: ACORV ADDITIONAL REMARKS SCHEDULE Page 2 Of 3 k.�. AGENCY NAMED INSURED Thermo Fluids Inc. Willis Towers Watson Northeast, Inc. 42 Longxater Drive POLICY NUMBER Norwell, NA 02061 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS 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: 1000005140 EFF DATE: 11/01/2025 EXP DATE: 11/01/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation i &npl Liab E.L. EACH ACCIDENT $2,000,000 (AK, AZ, IA, NJ, NY, NC, VT, CT) E.L. DISEASE - EA EMP $2,000,000 Per Statute E.L. DISEASE-POL LMT $2,000,000 INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company NAIC#: 38318 POLICY NUMBER: 1000005138 (MA, FL) EFF DATE: 11/01/2025 EXP DATE: 11/01/2026 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation E.L. EACH ACCIDENT $2,000,000 6 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 6 Liability Company NAIC#: 38318 POLICY NUMBER: 1000679513251(MA) EFF DATE: 11/01/2025 EXP DATE: 11/01/2026 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 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 28723631 BATCH: 4183453 CERT: W41461553 30156: 2 of 4 AGENCY CUSTOMER ID: _ LOC#: A� ADDITIONAL REMARKS SCHEDULE Page 3 Of 3 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Thermo Fluids Inc. 42 Longwater Drive POLICY NUMBER Norwell, NA 02061 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 1 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: COO G27416603 011 EDT DATE: 11/01/2025 EXP DATE: 11/01/2026 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 011 EDT DATE: 11/01/2025 EXP DATE: 11/01/2026 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 (2008/01) ®2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 28723631 BATCH: 4183453 CERT: W41461553 30156: 3 of 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: 1000679502251 Effective Date: 11/1/2025 Named Insured: Clean Harbors, Inc. 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. 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. 30156: 3 of 4 i 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: 1000679513251 Effective Date: 11/1/2025 Named Insured: Clean Harbors, Inc. 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. 30156: 4 of,' i POLICY NUMBER: 1000090736251 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement;or 1. In the performance of your ongoing operations; 2. Available under the applicable limits of or insurance; 2. In connection with your premises owned by or whichever is less. rented to you. This endorsement shall not increase the However: applicable limits of insurance. 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. CG 20 26 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1 30156: 4 of 4