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PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MMrGOYYY) 061302015 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 to an ACINTIONAL INS1UREbT_tFo­p6Ilcy(Ies) must be err arse . 1f SUBROGATION 13 WAIVEID, 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 4) certificate holder In lieu of such endorsement(s). c PRODUCER CQNTACr� NAME:, Aon Risk Services South,.. Inc. AX ^ ... ... .. C866) 283 -7122 F (800) 363 -0105 ` Atlanta GA Office (AJC.N7:" IA1C. No. EXD: IARL No ^.. .. 3565 Piedmont Rd NE,Blgl, #700 n bHESS: _ Atlanta GA 30305 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED - ^� INSURER A: Trans Pacific Ins - �- Co 41238 ,..INSURER B: Pacific "f'i c X�ndemni ty CO ............. .....,_._.- ....�.............. 120346._..- ,...,.,......... ZOLL medical corporation ( and Subsidiaries INSURERC: MltsUiSUmIf6i0 InsUr -. ^. ^.. ^. •-- .... ^.� ^..,, ^, ..---- �..... ��.. 269 Mill Road » .... ance u5A nc, 51 .............. �_. _.................... — 225... ..... Chelmsford MA 01824 -4105 USA INSURER D: Federal insurance Company 120281 INSURER E _� -" _., . _..- ..,.,.,..,.. ... -..... ..... ,.,. ..... ma,,, -..... INSURER F: COVERAGES CERTIFICATE NUMBER: 570058510890 REVISION NUMBER: _ THIS PS TO CERTIFY THAT'I'VIE POLICIES IES 017 INSURANCE LISTED BELOW 1-f E BEEN ISSUED TO THE INSURED 14AMED ABOVE H.)II THE POLICY PERU) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE IS -SUED OR MAY PERTAIN, TIME 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, Limits shown are as ro ° uosted II»I.,n X COMMERCIAL GENERAL LIABILITY I fP 6V O mil. ^µ , � �� - NUMBER OI pY " LIMITS A TYPE OF INSURANCE p CP-,_ POLICY YY TAPI,Yt) "V% - EACH OCCURRENCE $1,000,000 PfAIfACII YOTiTNTILT 0 .9 CLAIMS -MADE I X OCCUR $1 000 5,r✓hdC5E5i IC,;emec.rrarwearw;eY i 000 MED EXP (Any one person) $10,000 ..�,............,,,, - „.,,....�».,^. ^_,^ -...- ..... - -.._. WPERSONAL BADVINJURY _ ._.- .......1,0 $1,000,000' ° _ _ __ m GEN'L AGGREGATE LIMIT APPLIES PER �GE» GENERAL AGGREGATE $2,000,000 - Ln 0 X POLICY ❑ JE �. LOC PRODUCTSYY COMP70P AGG _ mm ..m,.. N 0 OTHER: ° _ .. N A AUTOMOBILE LIABILITY CPP 6403426 -05 OT/01/2015 07/01/2016 GO MBINED SINGLE LIMIT $1,000,000 (Fa accldenll X ANY AUTO BODILY INJURY ( Per person) 0 ALL OWNED SCHEDULED BODILY INJURY (Per .._cid_. n_Q N AUTOS AUTOS PROPERTY DAMAGE 0 HIRED AUTOS (Per accident) !_ AUTOS ” NON•OWNED «,. ,m..- ......... t: C EXSS 00217 07 01/2015 CH OCCURRENCE $ 0 000 OOU U X UMBRELLA LIAR'°°` X OCCUR _ EXCESS LIAR II CLAIMS MADE AGGREGATE pED RETFNTION B WOAK9RSCOMPENSATIONAND _..4 7/Ul7 %/ 1/ 201 b PER 0TH OrrILROPRIETORl PARTNER/ T"NN E,L ^D DISEASE-EA "E— MPLOYEE $1,000,00 EMPLOYERS' LIABILITY ANY P N 0 ' E:NemEruwPo[try'XE,4U,�E'�i:r' "r .......,,,.I NIA CMandnrery In N"I _ 0 CI ga l'' do scribe undar E.L. DISEASE - POLICY LIMIT $1,�_... ISdC�IC.RIPVIION OF OPERAIJONS'IkaIa�w +, 000 0001 ._...... D Products Liab _ 3601926 07/01/2015 07 ul 2olti Prop t:omrolr les /Agg 35,000,000 Retro Date 10/1/2004 Prod /comp 0ps /Occ $5,000,000 Deductible $200 000 ProdulctsNLiabilig - claims pmadesioverof iOl, Additional Remarks Schedule, may be attached If more space Is required) Premises /lipe rations. city EloSegundogis Included as Additional Insured in is accordance with thhe olic of El Segundo in accordance with the policy provisions of the workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of El Segundo AUTHORIZED REPRESENTATIVE, Attn: Carol Lynn Anderson taIT 350 Main Street El Segundo CA 92045 -3613 USA '.CJldfelf c.�J -.f� IT ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000057723 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services south, Inc, ZOLL Medical corporation POLICY NUMBER see certificate Number: 570058510890 CARRIER TNAIC CODE See Certificate Number: 570058510890 EFFECTIVE DATE: ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate farm for policy limits. ACORD 101 (20DBI01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a ^arl:dd,:r H)l.ttF INSR LTR TYPE OF INSURANCE A °0011, INSD SUER WVD POLICYNUMBF.R EFFECTIVE EXPIRATION LIMITS DATE DATE CM t tdTuYVYY' tMMlltnaYYYYy EXCESS LIABILITY �. D 79882432 07/01/201S WOWU16 Aggregate $5,000,000 Ex Products Liab Each $5,000,000 i occurrence ACORD 101 (20DBI01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TRANS PACIFIC INSURANCE COMPANY A New York Stock Company TOMOMARINE NICHIDO SCHEDULE OF NAMED INSUREDS IL9 05 003 (cont.) THE NAMED INSURED ON FORM IL9 05 003 IS AMENDED TO READ: ASAHI KASEI AMERICA, INC. ASAHI KASEI PLASTICS NORTH AMERICA, INC. SUN PLASTECH INC. AKM SEMICONDUCTOR, INC. ZOLL DATA SYSTEMS, INC. ZOLL SERVICES, LLC ZOLL MEDICAL CORPORATION 5 I L9 05 004 02 08 ®Tokio Marine Management, Inc. 2008 Page 1 Thls endorsement changes policy CPP6403426 -05 to which it is attached and is effective 07/01/2015 at 12:01 a.m, standard time at the Insured's mailing address. Issued to: ASAHI KASEI AMERICA, INC. Issued by: Trans Pacific Insurance Company Producer: AON RISK SERVICES SOUTH INC. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED - AUTOMATIC ADDITIONAL INSUREDS This endorsement modifies Insurance provided under the following: COMMERCIAL, GENERAL LIABILITY COVERGE This endors( AL, AK, GA, HI, „ MD, MA, NJ, NM, SC, SD, WI, WY )ment AZ, ID, MI, NC, TN, Ippiies AR, IL, MN, ND, TX, to the follow CA, CO, IN, IA, MS, MO, OH, OK, UT, VT, ng ste CT, KS, MT, OR, VI, tes: DE, KY, NE, PA, VA, DC, FL, LA, ME, NV, NH, PR, RI, WA, WV, AMENDED- AUTOMATIC ADDITIONAL INSURED Paragraph 11., Automatic Additional Insureds, of The General Liability Extended Coverage Endorsement, is replaced by the following: 11. Automatic Additional Insureds a: WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization, if: (1) You are required to do so under a written contract, agreement or permit, or (2) Your insurance producer issues a certificate of insurance on your behalf evidencing additional insured status to the certificate holder GI-9 99 001 09 11 Tokio Marine Management, Inc. 2011 Produmr ropy Page 1 POLICY NUMBER: CPP6403426 -05 AMENDED -IT AUTOMATIC ADDITIONAL INSUREDS (CONTINUED) but only with respect to liability arising out of your operations or premises owned by or rented to you. b. However, the insurance provided by this paragraph for Automatic Additional insureds does not apply to: (1) Any written contract or agreement or any certificate of insurance that was executed subsequent to the "bodily injury ", "property damage ", "personal injury" or "advertising injury "; (2) Any permit that was issued subsequent to the "bodily injury ", "property damage ", "personal injury" or "advertising injury "; or (3) Any written contract or agreement with a vendor for the distribution or sale of "your products ". GI-9 99 00109 11 Tokfo Marine Management, Inc. 2011 Pte'' Page 2 Name & Mailing Address of the Insured ASAHI KASEI AMERICA, INC, 800 THIRD AVENUE 30TH FLOOR NEW YORK NY 10022 FEIN 132698638 Name & Address of the Producer Attached to and Forming Part of Policy Number (16)7174 -99 -22 Policy Period 07/01/15 to 07/01/16 Effective Date 07/01/15 AON RISK SERVICES SOUTH, INC. Name of Company 3565 PIEDMONT RD NE S700 PACIFIC INDEMNITY COMPANY ATLANTA GA 30305 Endorsement Number Producer Number 6 -32811 999 EXTENSION OF INFORMATION PAGE ITEM 1. NAMED INSURED It is agreed that Item 1 of the Workers Compensation and Employers Liability Policy Information Page includes the following Named Insureds: NAME OF INSURED 0001 ASAHI KASEI AMERICA, INC. 0002 ASAHI KASEI PLASTICS AMERICA, INC. 0003 CRYSTAL IS, INC. 0004 ASAHI KASEI PHARMA AMERICA CORPORATION 0005 ASAHI KASEI BIOPROCESS AMERICA, INC. 0006 ASAHI KASEI MEDICAL AMERICA, INC. 0007 ASAHI KASEI PLASTICS NORTH AMERICA, INC. 0008 SUN PLASTECH INC. 0009 ZOLL MEDICAL CORPORATION 0010 ZOLL DATA SYSTEMS, INC. 0011 AKM SEMICONDUCTOR, INC. 0012 ADVANCED CIRCULATORY SYSTEMS, INC. 0013 FAIRFILED PL, WEST CALDWELL NJ (F /K /A IMPACT) 0014 ZOLL SERVICES, LLC 0015 ZOLL CIRCULATION, INC. 0016 ZOLL MANUFACTURING CORPORATION 0017 BIO- DETEK, INCORPORATED 0018 EN -PRO MANAGEMENT INC. 0019 ZOLL LIFEVEST HOLDINGS LLC F.EJ.N. 132698638 133498415 331222464 NJTIN:331222464000 204815808 263768762 201196096 381842563 223449513 NJTIN :223449513000 042711626 NJTIN::042711626000 650461124 NJTIN;:650461124000 770404174 NJTft 770404174000 411886489 042711626 NJTIN:042711626000 201121194 NJTIN:201121190000 943267204 NJTIN:943267204000 464199272 043058832 113683395 474199272 All Other Terms and Conditions Remain Unchanged Reference Copy Authorized Representative r.- $- 11111111^* IIW M � � ,x7003 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 124 (4 -84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 07/01115 at 12:01 A. M. standard time, forms a part of DATE) Policy No. (16)7174 -99 -22 of the PACIFIC INDEMNITY COMPANY (NAME OF INSURANCE COMPANY) issued to ASAHI KASEI AMERICA, INC. Endorsement No. ut ed Repre t va 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 AS REQUIRED BY WRITTEN CONTRACT Reference Copy WC 124 (4 -84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Page 1 of 1