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ACC>R& CERTIFICATE OF LIABILITY INSURANCE
<br />GATE 1212612016 IYYYY)
<br />2016
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 014LY 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 pollcy(les) 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 endorsements).
<br />PRODUCER
<br />MARSH USA INC.
<br />99 HIGH STREET
<br />BOSTON, MA 02110
<br />Attn: Boston.Cer(Request@Marsh.com I Fax: 212-948-4377
<br />CONTACT
<br />'SAME:
<br />PHONE 5xn• A C No
<br />EDoeesa
<br />INSURERISI AFFORDING COVERAGE
<br />NAICR
<br />INSURER A: National Union Fire Insurance Company
<br />19445
<br />DWEIB
<br />INSURED Schneider Electric Holdings, Inc.
<br />(See page 2 for Additional Named Insureds)
<br />INSURER B I Now Hampshire Insurance Co.
<br />23841
<br />INsurl C I HDI•Gerling America Insurance Company
<br />41343
<br />200 North Martingale Road, Suite 1000
<br />Schaumburg, It. 60173
<br />INSURER D: Illinois National Insurance Company
<br />--
<br />23817
<br />INSURERE;
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: NYC-008016674�22 REVISION NLIMRFR-13
<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 CONTRACTOR 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 />T
<br />'TYP40FINSURANCE
<br />ADOL
<br />SUER
<br />POLICYN MBER
<br />POLICY EFF
<br />MIDD YY Y
<br />POLICY EXP
<br />M IODMYVy
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />u
<br />Contractual Liability
<br />X
<br />X
<br />2039174
<br />0110112016
<br />01101I2017
<br />EACH OCCURRENCE
<br />$ SAoo,000
<br />0 TE
<br />PREMISES fee re ce
<br />$ 5,000,000
<br />X
<br />MED EXP (Any one potion)
<br />$ 6,000
<br />PERSONAL &ADV INJURY
<br />-$ 6,000,000
<br />GEN. AGGREGATE LIMITAPPLIE�3 PER!
<br />X POLICY ❑PRCTO Lr'LOG �
<br />JE
<br />GENERALAGGREGATE
<br />$ 6,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 5,000,000
<br />$
<br />OTHER:
<br />A
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />X
<br />9734256(AGE)
<br />9734254(Ml
<br />0110112016
<br />0110112016
<br />01/01/2017
<br />0110112017
<br />COMBINED SINGLE IMIT
<br />-MILaccident)
<br />$ 5,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />g
<br />_
<br />_
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NONAWNED
<br />AUTOS
<br />9734265(VA)
<br />0110112018
<br />0110112017
<br />BODILY INJURY accident)
<br />$
<br />PROPERTY DAMAGE
<br />Pe acc e t
<br />.,-
<br />X
<br />UMBRELLA LIAR
<br />X
<br />I OCCUR
<br />CUD11986-04
<br />01101/2016
<br />0110112017
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 6,000,000
<br />EXCESS Use
<br />CLAIMS -MADE
<br />DED I RETENTION$
<br />§
<br />B
<br />WORKERS COMPENSATION
<br />YIN
<br />ANY PROPRIETOR/PARTNERiEXECUTIVE N
<br />OFFICERIMEMBER EXCLUOED7
<br />(Mandatory in Nlll
<br />byyes describe under
<br />DE34tRIPT10 OF OPERATIONS below
<br />NIA
<br />066022490 (ADS)
<br />Additional WCIEL policies are shown
<br />on the following e
<br />gPaA
<br />0110112016
<br />0110112017
<br />X PI
<br />ST UTE ER
<br />E, L. EACH ACCIDENT
<br />$ 5,000,000
<br />I DISEASE - EA EMPLOYEE
<br />$ 6,000,000
<br />E,L. DISEASE -POLICY LIMIT
<br />$ 6.000,000
<br />D
<br />PROFESSIONAL
<br />03-205.10.99
<br />0110U2016
<br />01101/2017
<br />EACH CLAIM I AGGREGATE 6,00l
<br />E&O LIABILITY
<br />POLICY I$ CLAIMS MADE
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLE (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />Re: Schneider Electric Mobility NA, Inc,
<br />City of Santa Ana, PWA— Transportation & Traffic Engineering Department are Included as additional Insured with respect to General and Auto liability. This Insurance Is
<br />primary and non-contributory over any existing Insurance and limited to liability arising out of the operations of the named Insured for General Liability and Automobile Liability.
<br />Waiver of Subrogalion Is Included In favor of the Certificate Holder under General Llablllty, Auto Liability, and VVorkers Con Zion
<br />REVIEWED BY. , EUNICE N REDIA,L J OF
<br />City of Santa Ana
<br />Alin: Vlnh Nguyen, P.E., Sr. Civil Engineer
<br />PWA —Transportation & Traffic Engineering
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Sarah A. Stevenson "fa,'•4 a.
<br />ACORD 26 (2014101)
<br />m 1005.2014 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />riahta reserved.
<br />
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