HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific
ACORD. CERTIFICATE OF LIABILITY INSURANCE Dp.
12/ -.
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR~
Marsh USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFh.
TWO LOGAN SQUARE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND
PHILADELPHIA, PA 19103-2797 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Attn: PHILADELPHIA.CERTS@MARSH.COM/FAX:
212-948-0360
424780-ALL-GAW-09-10 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: Insurance Company Of The State Of PA 19429
BRENNTAG PACIFIC, INC.
10747 PATTERSON PLACE INSURER B: Greenwich Insurance Company 22322
SANTA FE SPRINGS, CA 90670 INSURER C: XL Specialty Insurance Company
INSURER D:
INSURER E:
3
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.-.sR ADD TYPE OF INSURANCE POUCY NUMBER j:tOUCY EFFECTIVE POUCY EXPIRATION UMITS
LTR INSR DATE (MMfDD/YY) DATE (MM/DD/YY)
GENERAL UABlUTY EACH OCCURRENCE $ 2 000 OOC
A ~MMERCIAL GENERAL LIABILITY 0696955 01/01/09 01/01/10 DAMAGE TO RENTED $ 1,OOO,OO<J
PREMISESlEa occurence)
~ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 1 O,OOC
PERSONAL & ADV INJURY $ 2,000,OOC
GENERAL AGGREGATE $ 2,000,00C
GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGe:: $ 2,000,000
Xl POLICY n PRO- n
JECT LOC
B AUTOMOBILE UABlUTY RAD943713304 (AOS) 01/01/09 01/01/10 COMBINED SINGLE LIMIT 1,000,OOC
- RAD943713104 (MA) (Ea accident) $
B X ANY AUTO 01/01/09 01/01/10
= ALL OWNED AUTOS BODIL Y INJURY $
SCHEDULED AUTOS (Per person)
~
HIRED AUTOS I BODIL Y INJURY $
~
NON-QWNED AUTOS (Per accident)
~ PROPERTY DAMAGE
- (Per accident) $
GARAGE UABlUTY AUTO ONL Y - EA ACCIDENT $
=j ANY AUTO OTHER THAN EAACC $
I AUTO ONL Y: AGG $
EXCESS/UMBRELlA UABlUTY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
~ $
DEDUCTIBLE $
RETENTION $ ~
WORKERS COMPENSATION AND X IT~g$T~JN~ I IOJ~-
EMPLOYERS' UABlUTY
C RWR943509004 (WI) 01/01/09 01/01/10 .L. EACH ACCIDENT $ 1,000,OO<J
ANY PROPRIETORlPARTNERlEXECUTIVE 01/01/10 $ 1,OOO,OOC
C OFFICER/MEMBER EXCLUDED? RWD943509104(AOS) 01/01/09 uL. D!SEASE - EA EMPLOYEE
If yes, describe under .L. DISEASE - POLICY LIMIT $ 1,000,OOC
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCWSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: SUPPL YING CHEMICALS TO THE WATER TREATMENT PLANT LOCATED AT: 90 N. MOUNTAIN AVENUE, ASHLAND, OR 97520
THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT
FOR WORKERS COMPENSATION, WHERE REQUIRED BY WRITTEN CONTRACT.
CITY RECORDER
I
CERTIFICATE HOLDER
CLE-001929899-04
CANCELLATION
CITY OF ASHLAND, OR
ATTN:KARIOLSON
90 NORTH MOUNTAIN AVENUE
ASHLAND, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCEu.EO BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LlABIUTY OF ANY KIND
UPON THE INSURER,
~1J~=m~SENTATIVE
Mary Radaszewski
ITS AGENTS OR REPRESENTATIVES.
-h1~ ~d~~~
ACORD 25 (2001/08)
o ACORD CORPORATION 1988