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4LC�R0® CERTIFICATE OF LIABILITY INSURANCE V DATE12/12J2019 YYYY) 2019 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(in) 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). PRODUCER MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 07960-6454 CONTACT NAME: PHONE aC No: E-MAIL ADDRESS INSURERS AFFORDING COVERAGE NAIC# INSURERA: HDI Global Insurance Gom n 4*13 100129-RSS-19120 610 CICKO NOC60 INSURED SIEMENS INDUSTRY, INC. INSURERS: TmVelers Property Casualty Go. ofAmerica 25674 INSURER C : The Travelers Indemnity Company 25658 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 600894513 RERD: :NU NSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: NYC810269414-32 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. INSR LTR T)fPEOFINSUR%NCE AOOL SUBR POLICY NUMBER POLICY EFF NVDo POLICY E%P MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR GLD1110111 10101/2019 1010112020 EACHOCCURRENCE $ 1,D00,000 DAMAGE TO RENTED PREMISES Ea ooc.mmca $ 1,000,000 MED E%P (Any one person) $ 100,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLES PER: POLICY 0 PET LOC GENERALAGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGO $ INCL $ OTHER: B AUTOMOBILEUABILITY TC2J-CAP-7440L34A-19 10/012019 10101/2020 COMBINED SINGLE LIMIT Me aoddent $ 2,000,000 X BODILY INJURY(Per person) $ NIA ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) ( ) $ NIA X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per acdtlent $ NIA $ UMaRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION$ $ B G B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANYICER/M MBER XCLUD /E%ECUTIVE OFFICER/MEMBERE%CLUDEO7 (Mandatory In NH) If yea, describe under DE SCRIPTION OF OPERATIONS below NIA TC2J-UB-8049X508-19(AOS) TRK-UB-8049X51A-19AZ, MA, OR, WI ( ) TWXJ-UB-744OL338-19 OH&WA ( ) """"'$500K LIMIT I $500K SIR" Tfffff= 101010019 10N12019 10/01120 0 1010112020 10/0112020 X PER oTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ifmore space is required) RE: SIEMENS JOB# 2600077971, 51011CITY OF SANTA ANA SERVICE AGREEMENT SEEATTACHED CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee All riahts reserved_ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD