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SIEMENS, INC
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Last modified
1/14/2019 1:04:22 PM
Creation date
1/14/2019 12:59:56 PM
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Contracts
Company Name
SIEMENS, INC
Contract #
A-2017-289-01
Agency
Parks, Recreation, & Community Services
Council Approval Date
10/17/2017
Expiration Date
11/8/2020
Insurance Exp Date
10/1/2019
Destruction Year
2025
Notes
A-2017-289
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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />09/202018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer <br />PRODUCER <br />MARSH USA, INC. <br />445 SOUTH STREET <br />MORRISTOWN, NJ 07960-6454 <br />610 JWHITE NOC60 <br />INSURED <br />SIEMENS INDUSTRY, INC <br />BUILDING TECHNOLOGIES <br />1000 DEERFIELD PARKWAY <br />BUFFALO GROVE, IL 60089 <br />EDING COVERAGE <br />e: Travelers Property Casualty Co. ofAmerlca 25674 <br />COVERAGES CERTIFICATE NUMBER: NYC -010183628-36 RFVISIf1N NIIMRFR- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />(NSR <br />LTR <br />ADDLISUBRI <br />TYPE OFINSURANCE <br />-- POLICY EFF <br />POLICYNUMBER MMIOOIYYW <br />POLICY EXP <br />MMIODNYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />GLD11101-10 16/012016 <br />10/01/2019 <br />EACHOCCURRENCE <br />$ 1,006,000 <br />CLAIMS -MADE T' OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occuoence <br />$ 1,000,006 <br />MED EXP (Any one person) <br />_ _ <br />$ 166,000 <br />PERSONAL &ADV INJURY <br />$ 1,666,660 <br />LIMITAPPLIES PER:GENERAL <br />POLICY ❑J PRO- <br />JECT L LOC <br />$ 10,006,666 <br />GEN'LAGGREGATE <br />I X <br />AGGREGATE <br />PRODUCTS - COMPIOP AGO <br />--_ _ <br />$ INCL <br />--- <br />I $ <br />OTHER <br />S AUTOMOBILE LIABILITY <br />I ANYAUTO <br />TC2J-CAP-7440L34A-18 <br />10/012018 <br />10/01/2019Eaeac <br />tlED SINGLE LIMIT <br />mb <br />$ 2,000,000 <br />$ NIA <br />BODILY INJURY (Per person) <br />ONED SULED <br />X(AUTOS ONLY ALL <br />BODILY INJURY(Pereccident) <br />$ NIA <br />X HIRED X NON -OWNED <br />— _AUTOS ONLY _ AUTOS ONLY <br />PROPERTYDAMAGE <br />(Par eccldent) <br />$ NIA <br />_ <br />$ <br />X'. UMBRELLALIABI X OCCUR <br />I--' <br />CUD11102-10 <br />10/01/2018 <br />10/01/2019 <br />EACHOCCURRENCE <br />$ 1,006,000 <br />AGGREGATE <br />$ 1,606,060 <br />L _ EXCESS UAB CLAIMS -MADE <br />$ <br />DED t RETENTION$ <br />B <br />C <br />B <br />WORKERS COMPENSATION I <br />AND EMPLOYERS'LIABILITY YIN <br />ANVICERIM MBER XCLUD (EXECUTIVE <br />fMnCE18MEM BEREXCwOEO? N 'NIA <br />❑ <br />(Mandatory In NH) <br />under <br />DESCRIPTION <br />DESCRIPTION OF OPERATIONS below <br />TC2J-UB-8049X566-18(AOS) <br />TRK -UB 8049X51A-18AZ,MA,OR,WI <br />( ) <br />TWXJ-UB-7440L338-18 (ON <br />( ) <br />""""$500K LIMIT I $500K SIR"""" <br />10/01/2018 <br />10/01/2018 <br />10/0112018 <br />10/01/2019 <br />10/01/2019 <br />10101/2619Ifyca <br />X PER p'rH- <br />STATUTE ER_ <br />E.L. EACH ACCIDENT <br />_ <br />$ 1,000,000 <br />_ <br />E.L. DISEASE EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />$ 1,600,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,may be attached if more space is required) <br />RE'.SII#440P-231411 PROJECT NAME: SCA6-SES-COSA- PARKS SECURITY (MADISON, WINDSOR) <br />SEE ATTACHED,\�/�'v <br />CPRTIPICATF HAI DFP PAMPCI I ATInki . 6 _\o _G..% -- <br />CITY OF SANTA ANA <br />SHOULD ANY OF THE ABO <br />DESCRIBECIES BE CANCELLED BEFORE <br />20 CIVIC CENTER PLAZA <br />THE EXPIRATION DATE <br />THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA, CA 92701 <br />ACCORDANCEWITH THE POLICY <br />PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />of Marsh USA Inc. <br />Manashi Mukheriee <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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