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PROOF OF INSURANCE (2022) CLOSEDDATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/04/2021 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(ies) 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 endorsements . PRODUCER CONTACT MARSH USA, INC. NAME' PHONE I FAX 445 SOUTH STREET ( Q.Ji9�1Fx)• AIC No MORRISTOWN, NJ 07960-6454 EMAIL — CN102147003-RAM-PROF-21122 INSURED SIEMENS INDUSTRY, INC. 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089-4513 610 CICKO NOC60 rFRTIFIrATF IN11M RFR INSURER A: HDI Global Insurance Company wwww _ 41343 ..... _...... INSURERS: Travelers Propeo Casualty Co. of Amenca 25674 INSURER c : The Travelers Indemm) Co an 125658 INSURER D : NYC-010965556-38 REVISION NI.IM RFR-. 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 �...._... �... L m 06107CY FF PbLICY E?tP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER III IDDIYYYY .. 'DD Y. A X I COMMERCIAL GENERAL LIABILITY GLDIIIOI-13 10/01/2021 10/O1/2022 EACH OCCURRENCE $ 1,000,000 �iri� I I 1,000,000 CLAIMS -MADE PRI'MILE (Em occa rrazncop .._, ', $ MED EXP Any one person) $ 100,000 ..... PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY JPE LOC JEOT PRgDUCL COMP/OP AGG $ INCL $ OTHER; B AUTOMOBILE LIABILITY TC2J-CAP-744OL34A-TIL-21 10/01/2021 10/01/2022 COMBINED SINGLE LIMIT $ 2,000,000 .. _ X ANY AUTO BODILY INJURY (Per person) $ N/A X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) _-. $ N/A X HIRED X NON -OWNED PROPERTY DAKad'E $ N/A AUTOS ONLY AUTOS ONLY Per a id_ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ .................._...- 4EXCESSLIAB CLAIMS -MADE AGGREGATE 'm$ ED RETENTION $ $ B WORKERS COMPENSATION UMP83929A-21-51-K(AOS) 1 I I2 2 X PER OTH- C AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE UB-8P79233A-21-51-R (AZ,MA,WI) 10/01/2021 10/01/2022 STATUTE ER E L EACH ACCIDENT $ 1,000,000 NIA . ....... -'I, B OFFICER/MEMBEREXCLUDED? (Mandatory in NH) TWXJUB-7440L336-TIL-210H ( ) 10101/2021 10/OU2022 ... . ...... .. 1,000,000 $ A PROFESSIONAL LIABILITY EOD5618802 1010112021 10/01/2022 5,000,000 'Deductible: $1,000,000' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: 44OP-297661- CITY EL SEGUNDO PD EXHAUST FAN. PROJECT NO PW 20-15 SEE ATTACHED CK I Iflk;A I t MULUtK koAr4lo LLA I IU'N CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 150 ILLINIOS ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W �l ZL.191-0 19"e. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102147003 LOC #: Morristown 4cAnnITInNA1 RPMARKA _qC_HFI1111 F Paoe 9 of 9 AGENCY NAMED INSURED MARSH USA, INC. SIEMENS INDUSTRY, INC. 1000 DEERFIELD PARKWAY POLICY NUMBER BUFFALO GROVE, IL 60089-4513 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: „Certificate of LiabilityInsurance RE: 440P-297661 - CITY EL SEGUNDO PD EXHAUST FAN„ PROJECT NO. PW 20-15 CITY OF EL SEGUNDO AND CITY OF EL SEGUNDO - PUBLIC WORKS ARE HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES. SUCH INSURANCE AS IS AFFORDED BY THE ADDITIONAL INSURED ENDORSEMENT SHALL APPLY AS PRIMARY INSURANCE & OTHER INSURANCE MAINTAINED BY THE CERTIFICATE HOLDER SHALL BE EXCESS ONLY & NOT CONTRIBUTING WITH INSURANCE PROVIDED UNDER THIS POLICY, WAIVER OF SUBROGATION IS EFFECTUAL WHERE REQUIRED BY WRITTEN CONTRACT. COMPLETED OPERATIONS COVERAGE IS INCLUDED IN THE GENERAL LIABILITY POLICY, IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER UP TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS,. ACORD 101 (2008/01) 0443-01-00-0001938-0002-0006476 © 2008 ACORD CORPORATION. All rights I The ACORD name and logo are registered marks of ACORD N HD1 GLOBAL INSURANCE COMPANY MANUSCRIPT ENDORSEMENT # 32 Policy Number GLO11101-13 Named Insured SIEMENS CORPORATION Policy Period: Inception (M-D-Y) Expiration (M-D-Y) Effective Dateand Time of Endorsement 10-01-2021 10-01-2022 10-01-2021 12:01 a.m. Standard Time at Address of the Insured, This Endorsement Changes The Policy. Please Read It Carefully. This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Form Who is an insured is amended to include as an additional insured any person whom you are required to add as an additional insured on this policy under a written agreement, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf. The insurance coverage provided to such additional insured applies only to the extent required within the written agreement. The insurance coverage provided to the additional insured person shall not provide any broader coverage than you are required to provide to the additional insured person in the written agreement and shall not provide limits of insurance that exceed the lower of the Limits of Insurance provided to you in this policy, or the limits of insurance you are required to provide in the written agreement. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent, or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the written agreement specifically requires that this insurance apply on a primary basis, this insurance is primary. if the written agreement specifically requires this insurance apply on a primary and non-contributory basis this insurance is primary to other insurance available to the additional insured and we will not share with thatother insurance. This endorsement shall prevail over additional insured endorsements that may apply under this policy unless required otherwise in the written agreement. Authorized Representative All terms and conditions of the policy remain unchanged. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. Page .. POLICY NUMBER_ GLD11101-13 A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of person Or Organization: ANY PERSON OR ORGANIZATION TO THE EXTENT REQUIRED BY WRITTEN CONTRACT V Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0443-01-00-0001938-0004-0006478 Q Insurance Services Office, Inc., 2008 Page I of 1 0 POLICY NUMBER: TC2J-CAP-744oL34A-TIL-21 COMMERCIAL AUTO ISSUE DATE: 09-01-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage pro- vided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU HAVE AGREED TO ADD AS ADDITIONAL INSURED, BUT ONLY TO COVERAGE AND MINIMUM LIMITS REQUIRED IN A WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule Is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualities as an "insured" under the Who Is An Insured provi- sion contained in Paragraph A.1. of Section If - Cov- ered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section II - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 G Insurance Services Office, Inc., 2011 Page 1 of i POLICY NUMBER: TC2J—CAP-744OL34A—TIL-21 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the fallowing: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A.5., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any "accident" or "loss", provided that the CONDITIONS Section: "accident" or "lass" arises out of the operations 5. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver ap- ers To Us plies only to the person or organization desig- W e waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 02 15 0 2015 The Travelers Indemnity Company. All rights reserved. Pane 1 of ` Includes copyrighted material of Insurance Services Office, Inc. with its permission. 0443-01-00-0001936-0003-0006477 TRAY LERS' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 0313 (00)- POLICY NUMBER: UB-8P83929A-21-51-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 09-01-21 ST ASSIGN: