HomeMy WebLinkAboutInsurance Certificate: Brenntag Pacific Inc
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A:.CORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlVYVY)
1211512010
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 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 endorsementf~l.
PRODUCER CONTACT
Marsh USA Inc. NAME:
TWO LOGAN SOUARE I ~."!2~1f_ ____ . I rM No':
PHIlADELPHIA, PA 19103-2797 E-MAIL
Alln: PHILADELPHIACERTS@MARSH,COM/FAX.212-94Il-0360 ADDRESS:
PRODUCER
4247BO-'All-GAW-II-12 INSURER/51 AFFORDING COVERAGE HAle.
INSURED INSURER A : Insurance Company Of The State Of PA 19429
BRENNTAG PACIFIC,INC. INSURER B : Greenwich 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-002767164-13
REVISION NUMBER' 4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSUREO NAMEO ABOVE FOR THE POLICY PERIOO ..
INOICATEO. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAlO CLAIMS.
INSR TYPE OF INSURANCE ~~!>: I~.~.~~ POLICY EFF :~~}'y~~~\
LTR POLICY NUMBER MM/DDIYYYY LIMITS
A ~NERAl LIABILITY 0696955 01101/2011 01/0112012 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAl LIABILITY DAM~:I:~J9F~ENTED 1,000,000
PREMI ES E<i~ccurrence\ $
-l CLAIMS-MADE 0 OCCUR MED EXP (Anv one person) $ 10,000
e- PERSONAL & ADV INJURY $ 1,000,000
e- GENERAL AGGREGATE $ 2,000,000
m'L AGG~EnE LIMIT APnS PER: PRODUCTS. COMP/O? AGG $ 1,000,000
X POLICY 1:'8.9..: lOC . $
B ~OMOBILE LIABILITY RA0943713306 (ADS) 0110112011 0110112012 COMBINED SINGLE LIMIT 1.000,000
B RA0943713106 (MA) (Eaaccidem) $
~ 01,u112011 01Al112012
ANY AUTO BODILY INJURY (Per person) $
i- ALL OWNED AUTOS .
BODILY INJURY (Per accident) $
e- SCHEDULED AUTOS PROPERTY DAMAGE
$
e- HIRED AUTOS (Per accident)
i- NON.OWNED AUTOS $
$
L- UMBRELLA L1AB HOCCUR EACH OCCURRENCE $
EXCESS L1AB CLAIMS-MADE AGGREGATE $
e- DEOUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION X I T",('i,"T~)'~~ I IOJ'!!'
AND EMPLOYERS' LIABILITY
C VIN RWR943509006 (WI) 01/01/2011 01101/2012 1,000,000
ANY PAOPRJETOR/PARTNERlEXECUTIVE 0 EL EACH ACCIDENT $
C OFFICER/MEMBER EXCLUDED? NIA RWD943509106(AOS)
(Mandatory in NH) 01,u112011 01101/2012 E.l. DISEASE - EA EMPLOYEI $ 1,00Q,0Cl0
g~sc:~r~ b~~PERATIONS below E.L DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If moro space is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF ASHlAND THE EXPIRATION DATE THEREOF. NOnCE WILL BE DELIVERED IN
1195 OAK STREET ACCORDANCE WITH THE POLICY PROVISIONS.
ASHLAND. OR 97520
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
, Donna Clampitt </0- C,__~
ACORD 25 (2009109)
@ 198B-2009 ACORD CORPORATION. All rights reserved.
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