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HomeMy WebLinkAboutInsurance Certificate: Polydyne Inc. (2) AC" " DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 12/29/2C 1•x THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI; 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 CONTACT Andrea Kim PHONE 212.2934203 FAX EPIC Insurance Brokers&Consultants Arc No.Ezt: andrea kim�w 1140 Avenue of the Americas—8th Floor E-MAIL lcbrokere com New York, NY 10036 INSURERS AFFORDING COVERAGE NAIC N NSURERA: IRONSHORE SPECIALTY INSURANCE COMPANY 25445 INSURED INSURER B: HARTFORD FIRE INSURANCE COMPANY 19682 Polydyne Inc.One Chemical Plant Road INSURERC:— - - PO Box 250 INSURER D: 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 I ADDL SUBR LTR TYPE OF INSURANCE WVD POLICYNUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y IEPICB5ZFB006 12131121125 12/31/2026 EACHOCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTEDp S(Eao Re $500,000 -REMED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 10ABR30602 12/31/2025 12/31/2026 COMBINED SINGLE LIMITMe accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE AUTOS Per accident $ $ A UMBRELLA LIAB X OCCUR IEELCASB5ZFD006 12/31/2025 12/31/2026 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 1OWNR30600 12/31/2025 12/31/2026 X PE OTH- ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETO OFFICER/MEM ERP EXCLUDED?CUTIVE a NIA E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTIONOF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I 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 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD