HomeMy WebLinkAboutInsurance Certificate: Univar USA
ACORJ;J~T~
ATE (MM/DD/YYYV)
03/02/2009
PRODUCER
Aon Risk services Central, Inc.
Philadelphia PA office
One Liberty place
1650 Market Street
Suite 1000
Philadelphia PA 19103 USA
PHONE- 866 283-7122 FAX- 847 953-5390
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURER A: American International Specialty Lines 26883 ...
Q,)
INSURER B National union Fire Ins Co of pittsburgh 19445 '5
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Insurance Company of the State of PA 19429 Q,)
INSURER C "Cl
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Illinois National Insurance Co 23817 ...
INSURER D: Q,)
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INSURER E: ACE property & casualty Insurance Co. 20699 '"S
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INSURED
UNIVAR USA INC
500 108th Avenue NE, Suite 2200
Bellevue WA 98004-5580 USA
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIDCH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR DD'
LTR INS
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE(MM\DD\VY) DATE(MM\DD\VY)
03/01/09 03/01/10
LIMITS
B
~ERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
X SIR: $2,000,000
2802979
EACH OCCURRENCE
$3,000,000
$300,000
DAMAGE TO RENTED
PREMISES (Ea occurence)
MED EXP (Anv one person
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00
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PERSONAL & ADV INJURY
GENERAL AGGREGATE
$3,000,000
$3,000,000
$3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
~ POLICY D ;:g; D LOC
PRODUCTS - COMP/OP AGG
B AUTOMOBILE LIABILITI' 4806890 03/01/09 03/01/10
X ANY AUTO Truckers l i abil i ty (AOS)
B 4806891 03/01/09 03/01/10
ALL OWNED AUTOS Truckers liability (MA)
B SCHEDULED AUTOS 4806892 03/01/09 03/01/10
Truckers liability (VA)
HIRED AUTOS
NON OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
e
$5,000,000 Z
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BODILY INJURY
( Per person)
BODILY INJURY
(per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
E
B ANY AUTO
EXCESS /UMBRELLA LIABILITI'
~ OCCUR D CLAIMS MADE
OTHER THAN EA ACC
AUTO ONLY:
AGG
BE7235031
03/01/09
o 01 10
EACH OCCURRENCE
AGGREGATE
$4,000,000
IDDEDUCTffiLE
l8]RETENTION
$500,000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
c
B
1
AOS
1591222
ANY PROPRIETOR / PARTNER / EXECUTIVE CA OH
OFFICER/MEMBER EXCLUDED? "
1591223
If yes, describe under SPECIAL PROVISIONS WI
below
OR & WA
03/01/09
03/01/09
03/01/10
$1,000,000 _
-
$1,000,000 ~
$1,000,000 iii
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E.L. DISEASE-POLICY LIMIT
D
03/01/10
E.L. DISEASE-EA EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEillCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Bid #2008-101 & Bid 2008-102, Superfloc N-300 LMW; calcium Hypochlorite; Caustic Soda; Sodium Hypochlorite;
SBS; Location: Portland. city of Ashland and all employees are included as Additional Insured on the General
Liability and Automobile Liability policies with respect to written contract. univar is self-insured for physical
City of Ashland
Attn: Kari olson
90 N. Mountain Avenue
Ashland OR 97520 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRIITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFr,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Attacbmi:>nt to ACORD Certificate for UNIVAR USA INC
The t~rms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURER
INSURED
UNIVAR USA INC
500 108th Avenue NE, Suite 2200
Bellevue WA 98004-5580 USA
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
ADD'L POLICY NUMBER POLICY POLICY
INSR EFFECTIVE EXPIRATION
INSRD TYPE OF INSURANCE POLICY DESCRIPTION LIMITS
LTR DATE DATE
AUTOMOBILE LIABILITY
4806893 03/01/09 03/01/10 combined
B Comme rei a 1 Auto (AOS) single Limi $5,000,000
4806894 03/01/09 03/01/10
B Comme rei a 1 Auto (MA)
4806895 03/01/09 03/01/10
B Comme rei a 1 Auto (VA)
WORKERS COMPENSATION
1591221 03/01/09 03/01/10
c FL
1591224 03/01/09 03/01/10
D TX
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
damage to their vehicles.
Certificate No:
570033178318