|
Ac" R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE/2014 M Y)
<br />0912912014
<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 />CONTACT
<br />NAME:
<br />FAX
<br />PAHCNE Es : WC. No:
<br />EMAIL
<br />ADDRESS:
<br />MORRISTOWN, NJ 07960 -6454
<br />INSURERS AFFORDING COVERAGE
<br />NAIL#
<br />GLD1110106
<br />INSURERA:HDI- Gerling America Insurance Company
<br />41343
<br />100129- 6- 7BA -SBT1 -14115 610 Watson NOC60
<br />INSURED SIEMENS INDUSTRY, INC INCLUDING
<br />BUILDING TECHNOLOGIES S DIVISION
<br />INSURER B: The Travelers Indemnlly Company
<br />25658
<br />INSURER C: The Charter Oak Fire Insurance Company
<br />25615
<br />INSURER D: Travelers Property Casually Co, of America
<br />25674
<br />1000 DEERFIELD PARKWAY
<br />BUFFALO GROVE, IL 60089 -4513
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />INSURER E,
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: NYC - 006326833.10 REVISION NUMBER:
<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 />INSR
<br />R
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICYNUMBER
<br />POLICY I/YYW
<br />MMIDDYYXYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />GLD1110106
<br />10101/2014
<br />1010112015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />CLAIMS -MADE IX I OCCUR
<br />BED END (Any one person)
<br />$ 100,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 10,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS- COMPIOPAGG
<br />$ INCL
<br />X POLICY
<br />PRO LOG
<br />$
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />TC2JCAP7440L34A14
<br />10/0112014
<br />1010112015
<br />COMBINED SINGLE LIMIT
<br />2,000,000
<br />BODILY INJURY (P., person)
<br />$ NIA
<br />X
<br />ANY AUTO
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BOD ILY INJ DRY (Par accident)
<br />$ NIA
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ NIA
<br />X
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />CUD1110206
<br />1010112014
<br />10101/2015
<br />EACH OCCURRENCE
<br />$ 1,006,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />TC20UB744OL27114 (ADS)
<br />1010112014
<br />1010112015
<br />X I we STATUS OTH-
<br />CRY
<br />B
<br />D
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOREARTNERIEXECUTIVE YIN
<br />(Mandatory Excwoeoa ❑N
<br />(Mandatory In NH)
<br />N/A
<br />TRKUB7440L20314 (AZ, MA, OR & WI)
<br />TWXJUB7440L33814 OH &WA
<br />( )
<br />1010112014
<br />10101/2614
<br />1619112615
<br />1610112015
<br />E.L. EACH ACCIDENT
<br />1,666,999
<br />$
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,666,666
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />" "'$GOOK LIMIT / $500K SIR " "'
<br />EL DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />RE: JOB N0, NIA
<br />SEE ATTACHED
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTAANA
<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 />SANTAANA, CA 92701AD10
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|