Attachment_-_Supplemental_Insurance.pdf

H o ld e r Id e n ti fi e r

77777

77707 07070

00777 63616

06555 33307

72535 77702

75445 07442

12676 25371

00070 64045

73670 31000

77260 55750

47475 00770

26151 32274

13007 34267

77124 76730

07704 23577

62745 76071

62233 57203

67300 77727

25202 57731

10777 77770

70007 07007

66666

66606 06060

00626 06466

20444 62006

00022 62402

42222 06022

00626 22402

00062 02004

04026 20020

60022 04060

26222 20622

00042 60062

20206 00022

60622 62202

06222 22426

20620 22060

22266 20246

20400 66646

06224 06644

40666 66660

60006 06006

C e rt if ic a te N o

CERTIFICATE OF LIABILITY INSURANCE

DATE(MM/DD/YYYY)

07/02/2024

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).

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.

PRODUCER

Aon Risk Services Central, Inc.

Philadelphia PA Office 100 North 18th Street 15th Floor Philadelphia PA 19103 USA

PHONE

(A/C. No. Ext):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

(866) 283-7122

INSURED 36940Indian Harbor Insurance CompanyINSURER A:

38318Starr Indemnity & Liability CompanyINSURER B:

16109Starr Specialty Insurance CompanyINSURER C:

INSURER D:

INSURER E:

INSURER F:

FAX

(A/C. No.): (800) 363-0105

CONTACT

NAME:

American Air Liquide Inc.

Airgas, Inc.

259 N. Radnor Chester Road Radnor PA 19087-5240 USA

COVERAGES CERTIFICATE NUMBER: 570107059886 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, Limits shown are as requested

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

(MM/DD/YYYY)

SUBR

WVD

INSR

LTR

ADDL

INSD POLICY NUMBER TYPE OF INSURANCE LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

POLICY LOC

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

X

X

X

GEN'L AGGREGATE LIMIT APPLIES PER:

$2,000,000

$2,000,000

$1,000

$2,000,000

$6,000,000

$6,000,000

B 07/01/2024 07/01/20251000090660241

PRO-

JECT

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED AUTOS

ONLY

NON-OWNED

AUTOS ONLY

BODILY INJURY ( Per person)

PROPERTY DAMAGE

(Per accident)

X

BODILY INJURY (Per accident)

$2,000,000B 07/01/2024 07/01/2025

AOS

1000635789241B 07/01/2024 07/01/2025

MA

COMBINED SINGLE LIMIT

(Ea accident)

1000635788241

EXCESS LIAB

OCCUR

CLAIMS-MADE AGGREGATE

EACH OCCURRENCE

DED

UMBRELLA LIAB

RETENTION

E.L. DISEASE-EA EMPLOYEE

E.L. DISEASE-POLICY LIMIT

E.L. EACH ACCIDENT $1,000,000

X OTH-

ER

PER STATUTEC 07/01/2024 07/01/2025

FL, MA

1000004704C 07/01/2024 07/01/2025

$1,000,000

Y / N

(Mandatory in NH)

ANY PROPRIETOR / PARTNER /

EXECUTIVE OFFICER/MEMBER N / AN

WI

WORKERS COMPENSATION AND

EMPLOYERS' LIABILITY

If yes, describe under DESCRIPTION OF OPERATIONS below

$1,000,000

1000004702

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CANCELLATIONCERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVEAirgas, USA LLC 3737 Worsham Avenue Long Beach CA 90808 USA

ACORD 25 (2016/03)

©1988-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACO

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION

DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

WC Continued / Named Insured List

AGENCY CUSTOMER ID:

ADDITIONAL REMARKS SCHEDULE

LOC #:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance

EFFECTIVE DATE:

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSUREDAGENCY

See Certificate Numbe

See Certificate Numbe

Aon Risk Services Central, Inc.

570000093705

570107059886

570107059886

Page _ of _

American Air Liquide Inc.

Workers Compensation:

Policy No: 1000004701 (AOS) Policy Period: 7/01/2024 - 7/01/2025 Insurer: Starr Specialty Insurance Company Limits: Same as the Workers Compensation and Employers Liability limits shown on the first page of the Certificate

Policy No: 1000004703 (AK, AZ, CT, IA, NC, NJ, NY, VT) Policy Period: 7/01/2024 - 7/01/2025 Insurer: Starr Specialty Insurance Company Limits: Same as the Workers Compensation and Employers Liability limits shown on the first page of the Certificate

Policy No: 1000004712 (USL&H) Policy Period: 7/01/2024 - 7/01/2025 Insurer: Starr Indemnity & Liability Company Limits: Same as the Workers Compensation and Employers Liability limits shown on the first page of the Certificate

NAMED INSUREDS ON THE ABOVE-REFERENCED POLICIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING

COMPANIES:

American Air Liquide Inc.

Air Liquide Helium America, Inc.

Air Liquide Advanced Technologies U.S. LLC Air Liquide America L.P.

Air Liquide USA LLC Air Liquide Large Industries U.S. LP Air Liquide Electronics U.S. LP Air Liquide Global E&C Solutions US Inc.

Air Liquide Technical Services LLC Air Liquide Global E&C Solutions Mexico LLC Air Liquide Advanced Materials Inc.

Air Liquide Advanced Materials LLC Airgas, Inc.

Airgas Carbonic, Inc.

Airgas Doral, Inc.

Airgas Merchant Gases, LLC Airgas Priority Nitrogen, LLC Airgas Safety, Inc.

Airgas Specialty Products, Inc.

Airgas USA, LLC Airgas Nitrogen Services, LLC Nitrous Oxide Corporation Red-D-Arc Inc.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD