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Home My WebLink AboutInsurance Certificate: Univar USA Inc ...---, I DATE{MMlDDfYYYY) ACC>RIJ" CERTIFICATE OF LIABILITY INSURANCE ..........-.-- 0310112011 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, subjed to the tenns 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 Aon Risk services Central, NAME: Inc. I fAHONE (866) 283-7122 I f~.No.l: (847) 953-5390 phi 1 ade 1 phi a PA off; ce AJC.No. Ext): One Liberty Place E-MAJL 1650 Market Street t~gf~~~:ID#: 570000014538 Sui te 1000 phi 1 ade 1 phi a PA 19103 USA IN5URER(S) AFFORDING COVERAGE NAle# INSURED INSURER A:. chartis specialty Insurance company 26883 UNIVAR USA INC INSURER B: National union Fire Ins Co of pittsburgh 19445 17425 NE union Hill Road Redmond WA 98052-3375 USA INSURER C: Illinois National Insurance Co 23817 INSURER 0: Insurance Company of the State of PA 19429 INSURER E: ACE Property & casualty Insurance Co. 20699 INSURER F: :;; !E C .. :!! :;; ." '0 :J: COVERAGES CERTIFICATE NUMBER: 570041737739 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. limits shown are as reqUestlK n~ TYPE OF INSURANCE INSR WVD POLICY NUMBER ~ I 'MMID~ LIMITS B GENERALLIABIUTY Gl2802979 O~ EACH OCCURRENCE $3,000,000 ~ SIR applies per policy ter s & condi ions IUKl;rlll;U $300.000 ~ COMMERCIAL GENERAL LIABILITY PREMISES lEa occurrence\ _ CLAIMS-MADE 00CCUR MED EXP (Anyone person) S10,OOO ~ SIR: $2,000,000 PERSONAl & ADV INJURY 13,000,000 GENERAL AGGREGATE 13,000,000 - ~N'L AGGRE~E.lIMIT AP~ PER: PRODUCTS - COMPIDP AGG $ 3 , 000,000 I X I POLICY I I PRO- I 1 LOG B ~UTOMOBILE LIABILITY B ..2 ANY AUTO _ AlL OWNED AUTOS B _ SCHEDULED AUTOS _ HIRED AUTOS ~ NON OWNED AUTOS CA 480b~0 Truckers Liability (ADS) CA 4806891 Truckers liability (MA) CA 4806892 Truckers Liability (VA) 0-Y0I72011 03/01/201 ~~MBI~e.~,~INGLE LIMIT $5.000.000 m '" J:: '" ~ ;;: 8 ~ "' 03/01/2011 03/01/2012 BODILY INJURY ( Per person) BODILY INJURY {Per accident) Pp~?::;~t~AMAGE o z .. 1i u '" 'E .. (.) 03/01/2011 03/01/2012 ":.- UMBRELLA UAB lXT OCCUR EXCESS LIAB 11 CLAIMS-MADE DEDUCTIBLE XDOG =11 03/01/2012 SIR applies per policy ter 5 & condi ions EACH OCCURRENCE AGGREGATE $4.000.000 $4,000,000 D '- X RETENTION $ 500,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY FROPRIETOR {f'ARTNiZR {8<CCVTiVE OFFICER/MEMBER exCLUDED? (MandatorylnNH) ~~st~IPTI~N 'QnFdOPERATlONS below YIN ~NIA wc001S91220 AOS SIR applies 03/01/2011 03/01/2012 X I :'ferRY d~1lc:U-1 If?JH- per policy ter s-& condi ions E.L EACH ACCIDENT $1.000. 000 1==== $1.ooo.ooDiii $1.000.00~ ~ Z! ~ ~ ~ E.L. DISeASE-EA EMPLOYEE E.L. DISEASE.POllCY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES {Attach ACORD 101, AddlUonal Remar1l. Schedule, If more space Is required} RE: Bid #2008-101 & sid 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 liabllity and Automobile liability PDlicles with respect to written contract. univar is self-insured for physical damage to their vehicles. CERTIFICATE HOLDER CANCELLATION SHOULD ANt OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DElIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Attn: Kari olson 90 N. Mountain Avenue Ashland OR 97520 USA AUTHORIZED REPRESENTATIVE .~~9"~~~ ACORD 25 (2009/09) @1988.2009ACORD CORPORATION. All ri~ts reserved. The ACORD name and logo are registered marks of AC~TY RECORD!::R Attachment to ACORD Certificate for UNIVA. USA INC The tenns, 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 tenns, conditions, coverages or exclusions contained in the policy. INSURER I:"OSURED UNIVAR USA INC 17425 NE union Hill Road Redmond WA 98052-3375 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. I~SR ADDL SUBR POLICY NUMBER! POLICY EFF FOLlCY EXP LT. TYPE OF ISSURANCE I:"lSR WVD POLlC\' DESCRIPTIO;,\/ (MMlDDfYYYY) (MMIDDfYVVY) LIMITS AUTOMOBILE lIABILITY B CA 4806893 3/01/2011 03/01/2012 Combined SS.OOO.OOO commercial Auto (AOS) single limi - B CA 4806894 3/01/2011 03/01/2012 commercial Auto (MAl B CA 4806895 3/01/2011 03/01/2012 Commerci a 1 Auto (VA) WORKERS COMPENSATION B NfA wc1591222 3/01/2011 03/01/2012 CA, OH, OR & WA SIR applies per policy te ms & condit ons e NfA WCOO1591223 3/01/2011 03/01/2012 WI SIR applies per policy te ms & condi t ons 0 NfA wcOO1591221 3/01/2011 03/01/2012 Fl SIR applies per policy te ms & condit ons e NfA wcOO1591224 "I U"I LU", U'/U"I LUU TX SIR applies per policy te ms & condit ons Certificate No: 570041737739