HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific
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Clry RECORDER
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ACORD"~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlVVYV)
~. '~ 12/1512010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES 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 be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certal~~~.OIiCies 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
Marsh USA Inc. NAME:
TWO LOGAN SQUARE ~..~!?"!.7_ ""~'. 1 r:~ No':
PHIlADELPHIA, PA 191Q3.2797 E-MAIL
Attn: PHILADELPHIA.CERTS@MARSH.COMIFAX,212,94B<l360 ADDRESS:
PRODUCER ....
42478Q.'ALL:GAW,ll,12 INSURER/51 AFFORDING COVERAGE NAle.
INSURED INSURER A : Insurance Company Of The State Of PA 19429
BRENNTAG PACIFIC, INC. INSURER B : Green'Nich Insurance Company 22322
10747 PATTERSON PLACE
SANTA FE SPRINGS, CA 90670 INSURER C : XL Specialty Insurance Company
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER'
CLE'()()2767141,10
REVISION NUMBER' 3
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INOICATEO. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE INSURANCE AFFORDEO BY THE POLICIES DESCRleEO HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
INSR ADDL UBR 1,.r;oLlCY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MM/DDfYYYY MMIODfYYYY LIMITS
A ~NERAL LIABILITY 0696955 01101/2011 01101/2012 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~~J9E~~~~~r~e ce' $ 1.000,000
l CLAIMS-MADE 0 OCCUR MED EXP (Anyone person) $ 10,000
I- PERSONAL & ADV INJURY $ 1,000,000
"- GENERAL AGGREGATE $ 2,000,000
~'L AGGREGATE LIMIT APnS PER: PRODUCTS - COM PlOP AGG $ 1,000,000
X POLICY n ~flP.: . LOC .
B eOMOBILE UABIUTY RAD9437133ll6 (AOS) 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT $ 1.000.000
B ~ RAD943713106 (MA) 0110112011 01/01/2012 (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
e- ALL OWNED AUTOS BODlL Y INJURY (Per accident) $
'--- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
-
- NON-OWNED AUTOS $
$
- UMBRELLA UAB H OCCUR EACH OCCURRENCE $
EXCESS lIAB CLAIMS-MADE AGGREGATE $
- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION X I T\;x~~T~I,~~ I IOJ);"
AND EMPLOYERS' LIABILITY VIN
C ANY PROPRIETOR/PARTNERlEXECUTIVE 0 RWR943500006 (WI) 01101/2011 01101/2012 E.L. EACH ACCIDENT $ 1,000.000
C OFFICER/MEMBER EXCLUDED? NIA RWD943509106{AOS) 01101/2012 1,000,000
(Mandatory in NH) 01/01/2011 E.l. DISEASE - EA EMPLOYEE $
~~;~~f~ir~ ~~~PERATIONS below E.l. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required)
RE: SUPPLYING CHEMICALS TO THE WATER TREATMENT PlANT LOCATED AT: 9Il N. MOUNTAIN AVENUE, ASHlANO, OR 97520
THE CITY OF ASHlAND. OREGON, AND ITS ELECTEO OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED, EXCEPT FOR WORKERS COMPENSATION, WHERE
REQUIRED BY WRITTEN CONTRACT.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF ASHlAND, OR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: KARl OLSON ACCORDANCE WITH THE POLICY PROVISIONS.
9Il NORTH MOUNTAIN AVENUE
ASHLANO, OR 97520 AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
, Donna Clampitt <7>- C"-. Jr
ACORD 25 (2009109)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo Bre registered marks 01 ACORD