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PROOF OF INSURANCE (2023) CLOSEDT DATE (MMIDD/YYYY) CC)R ' CERTIFICATE OF LIABILITY INSURANCE 09/16/2022 111�, 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 endorsement(s). PRODUCER CONTACT MARSH USA, INC. NAME: N 445 SOUTH STREET -iAICo. Ex ); w- ( c,Not. ................M MORRISTOWN, NJ 07960-6454 A—MAIIL CN102147003-RAM-PROF-22123 610 WRIGH INSURED SIEMENS INDUSTRY, INC. 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089-4513 NOC60 INSURERS) AFFORDING COVERAGE NAIC # A: HDI ITGlobal Insurance Company ................ 41343 B ; Travelers Property Casoaltv Co. of America .__ 25674 ..� c : The Travelers Indemnity COmDany 25658 INSURER E 9'n111=0An=c RFRTIFICATF NIIMRFR• NYC-0091892138-54 RF"VI:w]014 NI1MRFR- 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. IIHS'itm .,. _ ..._-.................. _- LTR TYPE OF INSURANCE DO POLICY NUMBER. MO DD .EYY MM/DD/YYYY --- -- -_-- ---- � .... ........... LIMITS A X COMMERCIAL GENERAL LIABILITY GLD1110114 10/01/2022 10/0112023 EACH OCCURRENCE $ 1,000,000 m mmm CLAIMS -MADE OCCUR 1{FiLAE 1 t�FLtTY Eti... _. PREMISES Ea ocourrerjggj.. w $ 1,000,000 mmmmmmm MED EXP (Any one person) $ ....- .--- mmm111111111111 100,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L _-------------------m.. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000 ,000 POLICY PRG1 LOC ❑ JEGT PRODUCTS COMP/OP AGG ....CTS._.._....../ $ INCL X OTHER: � $ B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-TIL-22 10101/2022 10/01/2023 CC7MBINEDSINGLE LIM,I'I" Ea. a4+cadent $ 2,000,000 ...,,,,,A. X ANY AUTO person) BODILY INJURY (Per p $ NIA OWNED SCHEDULED BODILY INJURY (Per accident) $ NIA AUTOS ONLY AUTOS X HIRED Ix NON -OWNED PROPERTYDAMAGC $ NIA AUTOS ONLY AUTOS ONLY Weiraccidonll X UMBRELLA LIAB X OCCUR CUD1110214 10/0112022 10/01/2023 EACH OCCURRENCE $ 2,000,000 - .....,... .....,...... .............. EXCESS LIAR CLAIMS -MADE AGGREGATE 2 $ ,000,000 DED RETENTION $ $ B WORKERS COMPENSATION UB-8P83929A-22-51-K(AOS) ioTO172622 1 / 1/2023 X PER OTH- ER.... C AND EMPLOYERS' LIABILITY Y�'N/A UB-8P79233A-22-51-R AZ,MA,WI ( ) 10/01/2022 10/01/2023 1� -..... 0 OFFICER%MEMBER EXCLUDED? 10/01/2023 EACH ACCIDENT ..$ _ TyOOmmw B Mandato m NH (Mandatory ) TWXJUB-744OL338-TIL-22 OH ( ) 10/0112022 EL L, DISEASE - EA EMPLOYEE. $......_ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below """"""'$500K LIMIT I $500K SIR"""""" E,L DISEASE -POLICY LIMIT 1,000,000 A PROFESSIONAL LIABILITY EOD5618803 10101/2022 10/0112023 1,000,000 'Deductible: $1,000,000' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ALL OPERATIONS SEE ATTACHED CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CINDY MORTESEN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN OFFICE OF THE CITY CLERK ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245-0989 AUTHORIZED REPRESENTATIVE of Marsh USA Inc ©1988-2016 ACORD CORPORATION. All rights reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102147003 LOC #: Morristown C ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA, INC. SIEMENS INDUSTRY, INC. ...._._.�.�. ._..... ....�._. 1000 DEERFIELD PARKWAY POLICY NUMBER BUFFALO GROVE, IL 60089A513 CARRIER I NAIL CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance RE: ALL OPERATIONS CITY OF EL SEGUNDO, OFFICE OF THE CITY CLERK IS INCLUDED AS ADDITIONAL INSURED UNDER THE ABOVE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED THE ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NOW CONTRIBUTORY INSURANCE TO THE EXTENT THAT A CLAIM ARISES FROM THE NEGLIGENCE OF SIEMENS INDUSTRY, INC OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE INSURED BUT ONLY WITH RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT, THE OWNER AND CONTRACTOR WAIVE ALL RIGHTS AGAINST EACH OTHER AND ANY OTHER CONTRACTOR, SUBCONTRACTORS, SUB -SUBCONTRACTORS, AGENTS, AND EMPLOYEES, FOR DAMAGES OR INJURIES CAUSED BY PERILS TO THE EXTENT COVERED BY INSURANCE, EXCEPT SUCH RIGHTS AS THEY MAY HAVE TO PROCEEDS OF SUCH INSURANCE HELD BY THE OWNER AS A FIDUCIARY, 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) 0362-01-00-0001440-0002-0005361 © 2008 ACORD CORPORATION. All rights i The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2J—CAP-7440L34A—TIL-22 COMMERCIAL_ AUTO 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 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 "foss" 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- We 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 © 2015 The Travelers Indemnity Company. All rights reserved• Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: GLD11101-14 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF: RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: IANY PERSON OR ORGANIZATION TO THE EXTENT REQUIRED BY WRITTEN CONTRACT 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 0 insurance Services Office, Inc., 2008 Page 1 of 1 13 HD1 GLOBAL INSURANCE COMPANY MANUSCRIPT ENDORSEMENT# 32 Policy Number GLD11101-14 Named Insured SIEMENS CORPORATION Policy Period: Inception (M-D-Y) Expiration (M-D-Y) Effective Dateand Time of Endorsement 10-01-2022 10-01-2023 10-01-2022 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 iimits 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. 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 1S WRITTEN. Page I of t 0362-01-00-0001440-0003-0005362 TRAVELERS " �1�A,1 �'� �K WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC € 0 03 13 (00)- POLICY NUMBER: UB-8P83429A-22-5I-x 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: 08-29-22 0362-09-00-0000850-0004-0003266 ST ASSIGN: