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A� RO CERTIFICATE OF LIABILITY INSURANCE
<br />°0912 °""”'
<br />TYPE OF INSURANCE
<br />„20113
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />MARSH USA, INC.
<br />445 SOUTH STREET
<br />MORRISTOWN, NJ 07960 -6454
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />E-MAIL
<br />S:
<br />INSURER (S) AFFORDING COVERAGE
<br />NAIC 9
<br />GLDIIIO106
<br />INSURER A :HDI-Gerling America Insurance Company
<br />41343
<br />100129- 6- 7BA -SBT1 -13/14 610 Watson NOC60
<br />INSURED
<br />SIEMENS INDUSTRY, INC. INCLUDING
<br />Travelers Property Casualty Co. ofAmerica
<br />INSURER e; P Y Y
<br />25674
<br />INSURER C: The Charter Oak Fire Insurance Company
<br />25615
<br />BUILDING TECHNOLOGIES DIVISION
<br />1000 DEERFIELD PARKWAY
<br />BUFFALO GROVE, IL 60069 -4513
<br />INSURER O
<br />DAMAGETORENTEO
<br />PREMISES Ea occurrence
<br />INSURER E :
<br />MED EXP (Any one person)
<br />$ 100,000
<br />INSURER F,
<br />$ 1,000,000
<br />COVERAGES CERTIFICATE NUMBER- NVD.nnsg9AR1R -m pPVIClunm MIIMGCD•
<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 />INSRR
<br />TYPE OF INSURANCE
<br />ADDL
<br />R
<br />5 BR
<br />I MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDMIYY
<br />POLICY EXP
<br />(MMIDONMI
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />GLDIIIO106
<br />10/01/2013
<br />10/01/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CIAIMS-MADE IE OCCUR
<br />DAMAGETORENTEO
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 100,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERALAGGREGATE
<br />$ 10,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS COMP /OP AGG
<br />$ INCL
<br />X POLICY P R,01- LOC
<br />$
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />TC2JCAP7440L34A13
<br />10/01/2013
<br />10/01/2014
<br />COMBINEDSINGLELIMIT
<br />Ea accident
<br />2,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$ N/A
<br />X
<br />ALL OWN ED SCHEDULED
<br />AUTOS Auros
<br />BODILY INJURY Per accident
<br />( )
<br />$ N/A
<br />X
<br />HIRED AUTOS X NON-OWNED
<br />AUTOS
<br />PROPERTYDAMAGE
<br />Per accident
<br />$ N/A
<br />A
<br />X
<br />UMBRELLA LIMB
<br />X
<br />OCCUR
<br />CUD1110205
<br />10/0112013
<br />10/01/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 110001000
<br />DED RETENTIONS
<br />$
<br />C
<br />B
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />(Mandatory in NH) EXCLU ❑EDP ❑N
<br />If yes,
<br />DESCRIPTION under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA'
<br />TC20UB744OL27113(AOS)
<br />TRJUB7440L26313 (AZ, MA, OR &WI)
<br />TWXJUB7440L33813 (OH &WA)
<br />" "$500KLMT/$500K SIR
<br />10/01/2013
<br />10/0112013
<br />10/01/2013
<br />10/01/2014
<br />1010112014
<br />10/01/2014
<br />X WC STATU- OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E .L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
<br />RE, JOB NO N/A PROVE, D AS �f'rC)]O` F1 Ot `✓ .
<br />SEE ATTACHED r�.j' ;19,Q2`�/,k J`I T•,-lY rJ"G'i. / -L, {,.
<br />Lama A. Rossini
<br />Assistant City Att011
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ATTN: PURCHASING DEPT.
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92701 -4010
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashl Mukherjee
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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