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Digitally sigmd by Tan Reean <br />Tori Pierson �ee?an.11.1141a4231 <br />A� d' CERTIFICATE OF LIABILITY INSURANCE <br />°IOM2D21ATE Y, <br />829 zozl <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(ies) 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 rights to the certificate holder in lieu of such endomement(s). <br />PRODUCER <br />CONTACT <br />NAME'- <br />MARSH USA, INC. <br />PNONE - �- ----- -- FAX — -- <br />445 SOUTH STREETINC.No <br />: <br />EWAIL <br />ADDRESS: <br />MORRISTOWN, NJ 07960-6454 <br />INSURER(S)AFFOItDINGCOVERAGE <br />NAICN <br />CN102147DnRAM_PROF-21122 4433 WHITE NOC60 <br />INSURER A: FIX n nra CQ=nv <br />41343 <br />INSURED <br />SIEMENS INDUSTRY, INC. <br />INSURER B: Tr Iws Properly CamWty Co DfAran <br />25674 <br />— - <br />INSURER C : Thn Tmvelem Indwrinty Company <br />25658 <br />1000 DEERFIELD PARKWAY <br />INSURER D: <br />BUFFALO GROVE, IL 60089-4513 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: NYC.01097462404 REVISION NUMBER: 9 <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 15 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TR <br />TYPE OF NSURANCE <br />A <br />POUCYNUMBER <br />MOL. <br />PWDDNYFF <br />POLICYE)P <br />NOLI <br />MMRS <br />A <br />X <br />COMMERCIAL OENERALLUUIILmY <br />OLD11101-13 <br />10110112021 <br />101012022 <br />EACH OCCURRENCE $ 1,000,000 <br />CLNMSMADE 1XI OCCUR <br />PRF.MO ET Eeamunence $ 10N1,000 <br />MED EXP(Any one Fenian) S 100,000 <br />PERSONAL&ADVINJURY <br />S 1,000,000 <br />GERL AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />S 10,000,000 <br />X POLICYC jECo-T LOC <br />PRODUCTS-COMPIOPAGG <br />S INCL <br />a <br />OTHER: <br />B <br />N <br />OMMLEL Me <br />TCU-CAP-74401-34A-TIL-21 <br />10101CMI 10.101/2022 <br />COMBINED SINGLE UNIT <br />as .n <br />'�5 W 000 <br />20 <br />BODILY INJURY (Per Pelson) 5.---_ WA <br />X <br />ANY AUTO <br />X <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BOCILYINJURY(Pereadeenn! S NIA <br />X <br />HIRED NONOWNED <br />AUTOS ONLY X AUf05 ONLY <br />PRO 13AMAGE <br />(Per ecdden0 S WA <br />S <br />A <br />X <br />UNBRELLAUAB <br />X <br />OCCUR <br />CUD11102-13 <br />10101/2021 <br />101012022 <br />EACHOCCURRENCE IS 1.000,000 <br />AGGREGATE $ 1,000,000 <br />EXCESS IJABI <br />CLAWSWADE <br />- <br />DE0 RETENTIONS <br />3 <br />S <br />D <br />B <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LUIOLLITYSTA <br />ANYPROPRIETORIPARTNERIEXECUTNE YIN <br />OFFICERMEMNEREXCLUDE07 ❑N <br />(FFICERryln NH) <br />NIA <br />UBBP83929A.2151-K(AOS) <br />UB-BP79233A-21-51-R (AZ,MA,WI) <br />TWXJUR-744OL338-TIL-210H <br />( ) <br />101012021 <br />10A112021 <br />10N12021 <br />101012022 <br />101012022 <br />101012022 <br />X PERMTE ER <br />EL.EACHACCIDENT $ 1,000,000 <br />EL OISFASE-E4 EMPLOYEE 4 1,000,000 <br />B Yea, deeailbe under <br />DESCRIPTION OF OPENATX)NS bebw <br />' """SSBDK LIMITI$SWK SIR'""""' <br />EL.OISEASE-POLICYLIMIT S 1,0001000 <br />A <br />PROFESSIONAL LIABILITY <br />EOD5618802 <br />10112021 <br />10/012022 <br />2,W0,000 <br />'Deductible: S1,000,000' <br />DESCRIPTION OF OPERATIONS I LOCATI°NSI VEHICLES (ACORD 101, AddbimM RemerFa Scedule, may be alYCNe l if mom spa® is mpulmd) <br />RE: ALL OPERATIONS <br />SEEATTACHED <br />CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />A7Tt4: RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 CMC CENTER R". 4TH FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. <br />SANTAANA, CA 92701 <br />AUIHORnIIID REPRE9ENrAT1YE <br />of Mamh USA Inc. IN <br />RsvEvnn4NNanm Br <br />©1988.2016 ACORD COR 0 7au �rirtdaN <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD mww�D—a A- <br />