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PROOF OF INSURANCE (2016) CLOSEDDATE (MWDD/YYYY) ACOORV CERTIFICATE OF LIABILITY INSURANCE 01/2212016 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 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. RrA -- 445 SOUTH STREET ,rr NN FOP MORRISTOWN, NJ 07960.6454 - INSURER(SI AFFORDI NAIC # 100129- PPA -PPA -15116 610 ROLLIN NOC60 INSURER A: HDI- Geding America Insurance Company 11343 INSURED INSURER B: The Travelers Indemnity Company 25658 SIEMENS INDUSTRY, INC. _- ----• .... . —• - -•••- • BUILDING TECHNOLOGIES INSURER c ; Travelers Property Casually Co. of America 25674 .................. 1000 DEERFIELD PARKWAY _�_.,...........__. INSURER D BUFFALO GROVE, IL 60089 COVERAGES CERTIFICATE NUMBER: NYC - 008410877 -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. N5R TYPE OF INSURANCE cn nnin POLICY NUMBER POLICY EFFWU POLICY EXP LT'R _ _ MMlDD1Y"Y M'M'Ybb A X COMMERCIAL GENERAL LIABILITY GLD1110107 110101/2015 10/0112016 NCLAIMS -MADE X OCCUR !! GEN'L AGGREGATE LIMIT APPLIES PER: POLICY %( �Eai � LOC OTHER; C !.. AUTOMOBILE LIABILITY TC2JCAP7440L34A15 IX ANY AUTO ALL AUTOS PX••• NON-OWNED HIRED AUTOS AUTOS UMBRELLA LIAR x OCCUR N I f UD1110207 EXCESS LIAB IlN ".— uenoN C WORKERS COMPENSATION TC2JUB7440L27116 (ADS) B AND EMPLOYERS' LIABILITY YNl❑N ..? .. ._... 1,000,000 MED EXP (Any one oerson) S 100,000 PERSONAL & ADV INJURY ANY PROPRIETORIPARTNER /EXECUTIVE GENERAL AGGREGATE S 10,000,000 TRKU87440L28315 (AZ, MA, OR & WI) C OFFICER ry In N )EXCLUDED? (Myyandatory In NH) N / A COM 1111,„ IMLEUMIF (Fa 0000) TWXJUB744OL33815 OH & WA ( ) BODILY INJURY (Per person) nkgr..P10TOinhW r1F nPERCT1nMR halnw BODILY INJURY (Per accident) S N/A " " "'$500K LIMIT /$500K SIR' " "' 10/01/2015 10 /0112015 10/0112016 1010112015 1010112016 LIMITS PREM9ESQeR�aReurreure._ ..? .. ._... 1,000,000 MED EXP (Any one oerson) S 100,000 PERSONAL & ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 10,000,000 PRODUCTS - COMPIOP AGG S INCL S COM 1111,„ IMLEUMIF (Fa 0000) $ 2,000,000 BODILY INJURY (Per person) $ NIA BODILY INJURY (Per accident) S N/A mar E R '*d MWA 5 N/A Per acc #4i#lP�k S EACH OCCURRENCE $ 4 ,000,000 AGGREGATE S 4,000,000 S X STATUTE _EERH . E.L. EACH u..... 1,000,000 E.L. DISEASECIEA EMPLOYEE S........ E.L. DISEASE POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: AEMA- 145ACRC - ENGINEERING PLAN CHECK SVCS, CITY OF EL SEGUNDO SEE ATTACHED CERTIFICATE HOLDER CITY OF EL SEGUNDO ATTN: FLORIZA RIVERA, PW DEPT 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 (2014101) 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �iauaol.— ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RE: AEMA- 145ACRC —ENGINEERING PLAN CHECK SVCS, CITY OF EL SEGUNDO CITY OF EL SEGUNDO, ITS OFFICIALS, OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS AOCk' NAL INSURED UNDER THE ABOVE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NON- CONTRIBUTORY INSURANCE TO THE EXTENT THAT A CLAIM ARISES F A THE NEGLIGENCE OF SIEMENS INDUSTRY, INC. OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE INSURED BUT ONL VW RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HZ TRACT THE OWNER AND CONTRACTOR WAIVE ALL RIGHTS AGAINST ENY OTHER CONTRACTOR, SUBCONTRACTORS, SUB — SUBCONTRACTORS, AGENTS, AND EMPLOYEES, FOR DAMAGES OR INJURIES CAUSEE EXTENT COVERED BY INSURANCE, EXCEPT SUCH RIGHTS AS THEY MAY HAVE TO PROCEEDS OF SUCH INSURANCE HELD BY THE OWNE S1.00Q000 PROFESSIONAL LIABILITY IS INCLUDED UNDE�R'IHE GENERAL LIABILITY POLICY PER PROJECT AGGREGATE APPLIES. EXPLOSION, COLLAPSE & UNDERGROUND OVERAGE IS NOT EXCLUDED. CONTRACTUAL LIABILITY IS INCLUr1 UNDER THE GENERAL LIABILITY COVERAGE. COMPLETED OPERATIONS CO' 'RAGE IS INCLUDED IN THE GENERAL LIABILITY POLICY. IF THESE POLICIES ARE ',.ANCELLEsD FOR ANY REASON OTHER THAN NON- PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE H% UP TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100129 LOC #: Morristown ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA, INC. SIEMENS INDUSTRY, INC.. ..._....... BUILDING TECHNOLOGIES POLICY NUMBER 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: _Certificate of Liability Insurance RE: AEMA- 145ACRC —ENGINEERING PLAN CHECK SVCS, CITY OF EL SEGUNDO CITY OF EL SEGUNDO, ITS OFFICIALS, OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS AOCk' NAL INSURED UNDER THE ABOVE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NON- CONTRIBUTORY INSURANCE TO THE EXTENT THAT A CLAIM ARISES F A THE NEGLIGENCE OF SIEMENS INDUSTRY, INC. OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE INSURED BUT ONL VW RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HZ TRACT THE OWNER AND CONTRACTOR WAIVE ALL RIGHTS AGAINST ENY OTHER CONTRACTOR, SUBCONTRACTORS, SUB — SUBCONTRACTORS, AGENTS, AND EMPLOYEES, FOR DAMAGES OR INJURIES CAUSEE EXTENT COVERED BY INSURANCE, EXCEPT SUCH RIGHTS AS THEY MAY HAVE TO PROCEEDS OF SUCH INSURANCE HELD BY THE OWNE S1.00Q000 PROFESSIONAL LIABILITY IS INCLUDED UNDE�R'IHE GENERAL LIABILITY POLICY PER PROJECT AGGREGATE APPLIES. EXPLOSION, COLLAPSE & UNDERGROUND OVERAGE IS NOT EXCLUDED. CONTRACTUAL LIABILITY IS INCLUr1 UNDER THE GENERAL LIABILITY COVERAGE. COMPLETED OPERATIONS CO' 'RAGE IS INCLUDED IN THE GENERAL LIABILITY POLICY. IF THESE POLICIES ARE ',.ANCELLEsD FOR ANY REASON OTHER THAN NON- PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE H% UP TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD HDI- GERLING AMERICA INSURANCE COMPANY MANUSCRIPT ENDORSEMENT # 34 Policy Number Named Insured GLD11101 -07 SIEMENS CORPORATION Policy Period: Inception (M -D -Y) Expiration (M -D-Y) Effective Date and Time of Endorsement 10.01 -2015 10 -01 -2016 10 -01 -2015 12:01 am. Standard Time at Address of the Insured This Endorsement Changes The Policy, Please Read It Carefully. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Form Who is an insured is amended to include as an insured any person whom you are required to add as an additional insured on this policy under a written agreement. 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 that other insurance. This endorsement shall prevail over additional insured endorsements that may apply under this policy unless required otherwise in the written agreement. ,.a 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. Pagt _ POLICY NUMBER: Tc2J- CAP- 744OL34A- TIL -15 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FAM • This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorse- required of you by a written contract executed ment, the provisions of the Coverage Form apply prior to any "accident" or 'loss", provided that the unless modified by the endorsement. "accident" or "loss" arises out of the operations Paragraph 5. Transfer of Rights Of Recovery contemplated by such contract. The waiver ap- Against Others To Us of the CONDITIONS section plies only to the person or organization desig- is replaced by the following: nated in such contract. 5. Transfer Of Rights Of Recovery Against Oth- ers To Us We waive any right of recovery we may have against any person or organization to the extent CA T3 40 08 08 0 2008 The Travelers Companies. Inc. Page 1 of 1 POLICYNUMBER: GLD11101 -07 COMMERCIAL GENERAL LIABILITY CO 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 PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION TO THE EXTENT REQUIRED BY WRITTEN CONTRACT Information required to corn olete this Schedule. if not shown above. will be 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 IV Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 TRAVELER9'J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)_ 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 WHOM A WAIVER OF SUBROGATION IS REQUIRED BY CONTRACT OR AGREEMENT OR PERMIT, BUT COVERAGE IS LIMITED TO THE SCOPE OF THE WORK PERFORMED BY THE INSURED UNDER SUCH CONTRACT, AGREEMENT OR PERMIT. 4 DATE OF ISSUE: 09 -24 -15 ST ASSIGN: