SIEMENS INDUSTRY, INC. (2) - Laserfiche WebLink

Home Browse Search

A� 0 CERTIFICATE OF LIABILITY INSURANCE DATE 12018 YVYY) 04/12/2018® 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(les) 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 FAX No EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HDI Global Insurance Company 41343 100129 -SOT -CA WC -17/18 610 CICKO NOC60 INSURED SIEMENS INDUSTRY, INC. INSURER B: The Travelers Indemnity Company 25658 INSURER C: Travelers Propemy Casualty Co. of America 25674 BUILDING TECHNOLOGIES 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC -010269414-01 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIODNYW POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 71 OCCUR GLD1110109 10/01/2017 10/01/2018 EACHOCCURRENCE S 1,000,000 PREMI ES(TO -RENTED PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 100,000 PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- JECT FILOC GENERAL AGGREGATE 5 10,000,000 PRODUCTS - COMP/OPAGG $ INCL $ OTHER. C AUTOMOBILE LIABILITY TC2JCAP7440L34A17 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident) X ANY AUTO BODILY INJURY (Per person) $ N/A X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Par accident) $ N/A ( ) X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY(Per PROPERTY DAMAGE ... [dent $ N/A UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED IRETENTIONI 1 $ 1 C B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFCERMEMB REXCLUDED?ECUTIVE (Mandatory in NH) If yep, describe under°"$500KLIMIT DESCRIPTION OF OPERATIONS below NIA TC20UB8049X50817(AOS) TRKUB8049X51A17 AZ, MA, OR & WI ( ) TWXJUD7440L33817(OH &WA) / $500K SIR / 7 10/0112017 10/01/2017 10/01/2018 10101/2018 10/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,900,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: SIEMENS JOB# 2600077971, 5/01/CITY OF SANTA ANA SERVICE AGREEMENT SEE ATTACHED CERTIFICATE HOLDER CANCELLATION CLERK OF THE CITY COUNCIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1988 ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92702-1988 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _J*Lot'vta " :¢�-e.:r_ © 1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD