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Al 6Ra CERTIFICATE OF LIABILITY INSURANCE
<br />bU911912WIW IpD,YYYYI
<br />01D.
<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 INSVRER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND 'THE CERTIFICATE HOLDER.
<br />IMPORTANTI If the certificate holder Is an ADDITIONAL INSURED, the poliay(ies) must have ADDITIONAL. INSURED provisions or be ondorsia
<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 rights to the certificate holder In Ilou of auch andorsoment s .
<br />PRCOUCaR
<br />MnRSH USA, INC.
<br />446 SOUTH STREET
<br />MORRISTOWN, NJ 07960,6454
<br />N E CT
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<br />INSURERSAFFORDINGCOVERAGE
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<br />INSURER A t HDI Global lnau[andeC rn Ian
<br />41343
<br />10012"11--l8719 SII ANDRI NOC60
<br />INSURED
<br />SIEMENS INDUSTRY, INC.
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<br />U(„{SURERe; TfaV afs rtllee SaaII Ce.21Atl10rlca
<br />26674
<br />, t suRan c: The Travelers lndwwK(0om2g
<br />26668
<br />1000 DEERFIFLO PARKWAY
<br />BUFFALO GROVE, It 60080-4613
<br />2suRERDI,,,,_—"—
<br />NSURER EI
<br />COVERAGES CERTIFICATE NUMBER: NYO-010271339-11 REVISION NUMBERS
<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, NOTVMTHSTANDING 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.
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<br />, LIMITS
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<br />COMMFROIALaENER�ALLIABU.ITY
<br />CLAIMs-MADE 111 OCCUR
<br />GLD11101•10
<br />40/0112018
<br />1010112019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />oNT€D' G
<br />$ 11000.000
<br />$ 100,000
<br />MEDEXP(Anycne areor)
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />SENT AGGREGATE UMII"APPLIES PER
<br />X POLICY El vi ❑ LOG
<br />GENERALAGGREGATE
<br />I$ 10,000,C00
<br />PRODUCTS •COMPIOP AOG
<br />$ INCL
<br />$
<br />OTHER'.
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<br />AUTOMOSILa LIABILITY _.....
<br />TG2T-74A9L3Qh16
<br />11011207
<br />1018112019
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<br />Efl fiGCI Onl
<br />$ 2,900,090
<br />BODILY INdI1RY(Par Parson)
<br />$ NIA
<br />X ANY AUTO
<br />X OWNED FCHEDULED
<br />„ AUTO5 ONLY AUTOS
<br />X HIRE X NON OWNED
<br />_
<br />AU70SONLY AUTOS ONLY
<br />BOOILYINJURY(Poreccidant)
<br />__ _
<br />$ NIA
<br />gqOPERTYDANIAGE —'
<br />Por am del
<br />S NIA
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<br />$
<br />X
<br />UMBRELLA t.IAD
<br />X
<br />OCCUR ...
<br />OUD11102-10
<br />1010112018
<br />1010112019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS.LIAD
<br />CLAIM$ -MADE
<br />�.„m _
<br />-�'
<br />C
<br />DES RETENTION$
<br />WORKERSCOMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNEWEXEOUTIVE YIN
<br />OFFICCRIMEMBER EXOWDEO9 N❑
<br />(hlandalory 61 NH)
<br />NIA
<br />TC2 •096018 (AO)�"„„�1'0/OT7iG1'6"
<br />TRK„UB•0049X51A48(AL NA,OR,WI)
<br />1010112010
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<br />1010112019
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<br />EL ACHACCIDLNT
<br />$
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<br />E.I. DISEASE-EAEMFLOYEE
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<br />$ 1,000,000
<br />Vatl, 7a90Aba bador
<br />SCRIP' IION OF OPE TIONS below
<br />E, L, DISEASE -POLICY LIMIT
<br />$ 1,000,000
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<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 161,Addltlondl RBmarNa Sahedula,n.y7b'a"„.._.m....... more
<br />RE: 17.076
<br />SEE ATTACHED
<br />REVIEWED EUNICE HEREDIA (PC :I OF�).,
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA, TYRONE CHESANEK
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
<br />20 CIVIC CENTER PLAZA
<br />N"a T-„�4 ' ''N::;'•
<br />�•
<br />THE EXPIRATION DATE THI REOP, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA, CA 02702
<br />"'--
<br />=S 'rr
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SEP 9 � 2018
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Ioo,
<br />Y. •.__„.._.__._"`^:^..
<br />Manashl Mukherjee.,.i'+tAn,r,.:..,}A.wf,:,.n„y.ea.
<br />01988.2016 ACORD CORPORATION. All rights reserved.
<br />AGORD 26 (2018103) The ACORD name and logo are registered marks of ACORD
<br />A'-T L 7 -611 -
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