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HomeMy WebLinkAboutPW15-366 - Insurance Certificate - Univar, inc. - Liability Coverage - 03/01/2015 CERTIFICATE � LIABILITY INSURANCE [7ATFVMtv4 2016 YY} C2/212tI7O THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS 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(has) must be endorsed. If SU'BROGATI'ON 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 endorsement(s). .PRODUCER CONTACT NAME; Ann Risk Services central, Inc. PHONE (866) 283-7122 FAX 800-363_0105 rr Philadelphia PA Office (Arc.No. Exll: (ArC.No.): One Liberty Place E-MAIL 1.650 Market Street ADDRESS: ° suite 1000 Philadelphia PA 1.9103 USA INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: National Union Pire Ins Co of Pitt'sburgh 19445 Univar Inc. INSURERB: 3075 Highland Parkwway (suite 200 INSURER C: Downers Grove IL 60515 USA ''...,INSURE.RD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570061256824 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, EXCLUSION'S AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested NSR CY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIOD/YYYY MI" �DlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 1 1, EACH OCCURRENCE $3,000„000 CLAIaJ15-LADE X�OCCUR SIR applies per policy t.er s & condi .i e...ns DA.Ad"1="16 f1 Ems- s300„000 REMISES Ea occurrence. X SIR:S2,000,000 MED EXP(Any one person) EXC l tided PERSONAL FADVINJURY $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL,AGGREGATE $3,000,000 00 X POLICY 0 JE O O LOC PRODUCTS COMPIOP AGG $3,000,000 OTHER: 0 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea,accident ANY AUTO BOU9fl.Y INJURY f,Per person) 4 ALL OWNED SOHEOULEO BOMLY INJURY(Poo acdoenl) qi AUTOS AUTOS HIRED AUTOS NON-CWNE,®, PROPERTYDAp.M1.4GE U AUTOS (Per aocidenO = t p5 UMBRELLA LIAB OCCUR EACH OCCURRENCE U HCLAIMS-MADE EXCESS LIAB AGGREGATE. DED I RETENTION WORKERS COMPENSATION AND PER OTH- EMPLOYERS'LIABILITY Y N N STATUTE, E.R ANY PROPRIE:TORI PARTNER!E.?,ECVJ 1 E.L.EACH ACCIDENT OFFVCER1MEMBBR EXCLAJCEDT NIA (Mandatory in NH) E.1..,DISEASF-Ed,EMPLOYEE ff yes desvibe undo E1.. DISEASE-0111 OOY C_tlM1T _ IPTION OF S I HICLES CEtcyyRof KentO- Publicr workCNEngineering is includ Additional asRemarks Additional maybe Tnsuredattached with more respect required) the General Liability and Automobile 'z :9 Li l2Tlity policies per the attached endorsement. Coverage is Primary and Non-Contributory. Mir CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED (BEFORE THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gent - Public works Engineering AUTHORIZED REPRESENTATIVE " Attn: Nancy Yoshitake 400 west GowMe Kent WA 98032 USA c %[ c.9�x @1988-2014 ACORD CORPORATION'.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD - 3 DATE(MM/DD/YYYY) ,4 o CERTIFICATE OF LIABILITY INSURANCE D2/2412D,6 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 endorsement(s). PRODUCER CONTACT 'm0 AOn Ri sk Services Central, Inc. PHONE FAX Philadelphia PA Office (AC.No.Ext): (866) 283-7Z22 (A/CNo)_ 800-363-0105 One Liberty Place E-MAIL p 1650 Market Street ADDRESS: _ suite el 00 ph Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Illinois union Insurance Company 27960 Uni Var Inc. INSURERS: National Union Fire Ins CO of Pittsburgh 19445 3075 Highland Parkway suite 200 INSURER C: New Hampshire Ins Co 23841 Downers Grove IL 60515 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570061257409 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 requested LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDDNYYY) (MMfDDrYYYY1 LIMITS B X COMMERCIAL GENERAL LIABILITY GL2802979 t!53/01/2015 T67511= EACH OCCURRENCE $3,000,000 CLAIMS MADE ❑X OCCUR SIR applies per policy terns & conditions DAMAGE T RENTED $300,000 PREMISES Ea occurrence X SIR$2,000,000 MED EXP(Any one person) EXCl uded PERSONAL&ADV INJURY $3,000,000 p GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 ;! X POLICY F LOC PRODUCTS-COMPlOPAGG $3,000,000 m PRO- JECT 0 OTHER: C. B AUTOMOBILE LIABILITY CA 4806890 03/01/2015 06/01/2016 COMBINED SINGLE LIMIT $5,000,000 N Truckers Liability (ADS) Ea accident B X ANYAUTO CA 4806891 03/01/2015 06/01/2016 BODILY INJURY(Per person) O Z ALL OWNED SCHEDULED Truckers Liability (MA) BODILY INJURY(Per accident) m g AUTOS AUTOS CA 4806892 03/01/201S 06/01/2016 pROPERTYDAMAGE AUTOS y v HIRED AUTOS NON-OWNED Truckers Liabilit (VA) Per accident :. r m A X UMBRELLALIAB H OCCUR xCEG27380566002 03/01/2015 06/01/2016 EACH OCCURRENCE $4,000,000 CJ SIR applies per policy terns & conditions AGGREGATE $4,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTION C WORKERS COMPENSATION AND WCO21569602 03/01/2016 06/01/2016 X I STATUTE ERH EMPLOYERS'LIABILITY ANY PROPRIETOR I PARTNER/EXECUTIVE Y!N A05 E.L.EACH ACCIDENT $1,000,000 B OFFICEWMEMBEREXCLUDED? a NIA xwCO898944 03/01/2016 06/01/2016 (Mandatory in NH) CA, OH, OR & WA E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,DESCRIPTION under SIR applies i es per policy c terns & conditions E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS below PP P P Y I! DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE CITY OF KENT, ITS ELECTED AND/OR APPOINTED OFFICIALS, ITS OFFICERS, AGENTS, VOLUNTEERS, AND REPRESENTATIVES ARE INCLUDED As ADDITIONAL INSURED UNDER THE AUTOMOBILE LIABILITY POLICY INSOFAR AS THE WORK OBLIGATIONS AND ACTIVITIES PERFORMED BY THE NAMED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Kent Engineering Department AUTHORIZED REPRESENTATIVE Attn: Barbara Napier Project Coordinator 220 4th Avenue south ��'`_ Kent WA 98032 USA sbe4�+-G Asa ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000014538 LOC#: '4 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Central, Inc. univar Inc. POLICY NUMBER See Certificate Number: 570061257409 CARRIER NAIC CODE see Certificate Number: 570061257409 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# 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. INSR ADDL SUBR POLICY POLICY LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE DATE (MMIDDIYYYY) (MMIDD AUTOMOBILE LIABILITY B CA 4806893 03/01/2015 06/01/2016 Combined $5,000,000 Commercial Auto (AOS) Single Limi B CA 4806894 03/01/2015 06/01/2016 Commercial Auto (MA) B CA 4806895 03/01/2015 06/01/2016 Commercial Auto (VA) WORKERS COMPENSATION C N/A WCO21569600 03/01/2016 06/01/2016 MA, ND, WI, WY C N/A WCO21569597 03/01/2016 06/01/2016 FL C N/A WCO21569599 03/01/2016 06/01/2016 IL, KY, NC, NH, UT C N/A WCO21569601 AK, AZ, GA C N/A WCO21569598 03/01/2016 06/01/2016 NJ, PA ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD