COI- Nebraska State Purchasing Bureau.pdf
PDF 72 KB Posted
- Attached to
- Beverage Products with Equipment and Maintenance
- Solicitation number
- 6793 OF REBID
- Issued by
- Douglas County, Nebraska
About this file
This document is a Certificate of Liability Insurance for US Foods, Inc. related to a Request for Proposal from the Nebraska State Purchasing Bureau. The certificate confirms that US Foods, Inc. has the required commercial general liability, auto liability, excess/umbrella liability, and workers compensation insurance coverage. The Nebraska State Purchasing Bureau is included as an Additional Insured under the general liability policy. The contract opportunity is for the purpose of selecting a qualified Contractor to provide Beverage Products with Equipment and Maintenance to the State of Nebraska. The resulting contract may not be exclusive, as the State reserves the right to contract for the same or similar goods from other sources. The pricing terms, set asides, incumbents, funding requirements and sources, and other salient details were not included in the provided documentation.
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Text version
H o ld e r Id e n ti fi e r
77777
77707 07070
00777 61616
04557 11107
74435 10423
64553 07662
02555 25251
00072 77355
72473 10320
73427 31312
63222 10726
60746 27423
31107 25105
57123 75711
07637 31677
12355 46076
37502 70037
02000 76727
24203 57720
00777 77770
70007 07007
77777
77707 07070
00735 25677
11545 60007
32004 51347
21170 07320
11402 56331
76075 22337
60652 35500
74637 67217
52244 00707
26623 02473
11007 02236
73064 33151
07122 32634
31731 00071
23326 25217
31000 77756
16335 17655
40777 77770
70007 07007
C e rt if ic a te N o
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
06/26/2023
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.
Chicago IL Office 200 East Randolph Chicago IL 60601 USA
PHONE
(A/C. No. Ext):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 16535Zurich American Ins CoINSURER A:
40142American Zurich Ins CoINSURER B:
20699ACE Property & Casualty Insurance Co.INSURER C:
INSURER D:
INSURER E:
INSURER F:
FAX
(A/C. No.): (800) 363-0105
CONTACT
NAME:
US Foods, Inc.
9399 West Higgins Road Rosemont IL 60018 USA
COVERAGES CERTIFICATE NUMBER: 570100244206 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:
$4,000,000
$4,000,000
$10,000
$4,000,000
$8,000,000
$8,000,000
A 11/01/2022 11/01/2023GLO007567500
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)
$5,000,000A 11/01/2022 11/01/2023 COMBINED SINGLE LIMIT
(Ea accident)
BAP 0075674 00
EXCESS LIAB
X OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
$1,000,000
$1,000,000
11/01/2022UMBRELLA LIABC 11/01/2023G46828744006
RETENTION
X
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT $1,000,000
X OTH-
ER
PER STATUTEB 11/01/2022 11/01/2023
AOS
WC007567300A 11/01/2022 11/01/2023
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER /
EXECUTIVE OFFICER/MEMBER N / AN
WC Retro
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under DESCRIPTION OF OPERATIONS below
$1,000,000
WC007567200
EL Each AccidentEWS007567600 11/01/2022 11/01/2023 SIR applies per policy terms & conditions $1,000,000EL Disease - Policy
EL Disease - Ea Empl $1,000,000
Excess Workers CompensationA $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Request for Proposal. Nebraska State Purchasing Bureau is included as Additional Insured in accordance with the policy provisions of the General Liability policy.
CANCELLATIONCERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVENebraska State Purchasing Bureau Attn: Julie Dabydeen PCO 1526 K Street 130 Lincoln NE 68508 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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