DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/03/2021
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 have ADDITIONAL INSURED provisions or be endorsed. If
Holder Identifier :
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
NAME:
Aon Risk Services Central, Inc. PHONE FAX
(A/C. No. Ext):
(866) 283-7122 (800) 363-0105
Chicago IL Office (A/C. No.):
200 East Randolph E-MAIL
Chicago IL 60601 USA ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Zurich American Ins Co 16535
Southeastern Paper Group LLC. INSURER B: American Guarantee & Liability Ins Co 26247
50 Old Blackstock Road
Spartanburg SC 29301 USA INSURER C: Federal Insurance Company 20281
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570090181672 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
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY
Y CPO759289300 11/01/2021 11/01/2022 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR $1,000,000
PREMISES (Ea occurrence)
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
570090181672
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY X LOC PRODUCTS - COMP/OP AGG $2,000,000
JECT
OTHER:
A AUTOMOBILE LIABILITY Y BAP 7432154-00 11/01/2021 11/01/2022 COMBINED SINGLE LIMIT
$1,000,000
(Ea accident)
BODILY INJURY ( Per person)
Certificate No :
X ANY AUTO
SCHEDULED BODILY INJURY (Per accident)
OWNED
AUTOS
AUTOS ONLY PROPERTY DAMAGE
HIRED AUTOS NON-OWNED
(Per accident)
ONLY AUTOS ONLY
B X UMBRELLA LIAB X OCCUR AUC759289800 11/01/2021 11/01/2022 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED RETENTION
A WORKERS COMPENSATION AND WC743215100 11/01/2021 11/01/2022 X PER STATUTE OTH
EMPLOYERS' LIABILITY -
Y/N AOS
ANY PROPRIETOR / PARTNER / EXECUTIVE
Y
E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
7777777707070700077761616045571110747517226304466107642005772505102073741755374001210740715332374221007536332036137730077261100261473130766044157412756407626375722057453076727242035772000777777707000707007
7777777707070700073525677115456000762110442532513107770154131371074074377722470221400747372225302655107033266317433151070232372531730000703322724206211107022337243163110077756163351765540777777707000707007
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Custodial Cleaning Chemical Supplies For bid #:20-517.
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.
DeKalb County School District AUTHORIZED REPRESENTATIVE
1701 Mountain Industrial Boulevard
Stone Mountain GA 30083-1027 USA
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 570000088556
LOC #:
ADDITIONAL REMARKS SCHEDULE Page _ of _
AGENCY NAMED INSURED
Aon Risk Services Central, Inc. Southeastern Paper Group LLC.
POLICY NUMBER
See Certificate Number: 570090181672
CARRIER NAIC CODE
See Certificate Number: 570090181672 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
If a policy below does not include limit information, refer to the corresponding policy on the ACORD
ADDITIONAL POLICIES
certificate form for policy limits.
POLICY POLICY
INSR ADDL SUBR POLICY NUMBER LIMITS
EFFECTIVE EXPIRATION
LTR TYPE OF INSURANCE INSD WVD DATE DATE
(MM/DD/YYYY) (MM/DD/YYYY)
EXCESS LIABILITY
C 78194978 11/01/2021 11/01/2022 Aggregate $10,000,000
Each $10,000,000
Occurrence
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD