Loading...
PROOF OF INSURANCE (2019) CLOSED A�® CERTIFICATE OF LIABILITY INSURANCE I DATE CERTIFICATE 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' 445 SOUTH STREET PHONE FAX (A/C,No,Ext): (A/C,No): MORRISTOWN,NJ 07960-6454 I EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 100129-SBT--18/19 610 WRIGH NOC60INSURERA:HDI Global Insurance Company 41343 INSURED INSURER B:Travelers Property Casualty Co.of America 25674 SIEMENS INDUSTRY,INC BUILDING TECHNOLOGIES I INSURER C:The Travelers Indemnity Company 25658 1000 DEERFIELD PARKWAY I INSURER D: BUFFALO GROVE,IL 60089 I INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009189268-42 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY GLD11101-10 10/01/2018 10/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE RETE CLAIMS-MADE IX I OCCUR PREM SESO(Ea occur ence) $ 1,000,000 MED EXP(Any one person) $ 100,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ INCL JECT OTHER: $ B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-18 10/01/2018 10/01/2019 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(Per accident) $ N/A X HIRED X NON-OWNED PROPERTYDAMAGE $ N/A AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLALIAB � OCCUR CUD11102-10 10/01/2018 10/01/2019 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION TC2J-UB-8049X508-18(AOS) 10/01/2018 10/01/2019 X PER OTH- AND EMPLOYERSLIABILITY STATUTE ER ' C Y/N TRK-UB-8049X51A-18(AZ,MA,OR,WI) 10/01/2018 10/01/2019 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) TWXJ-UB-7440L338-18(OH&WA) 10/01/2018 10/01/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under """"$500K LIMIT/$500K SIR"""" 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE ALL OPERATIONS SEE ATTACHED CERTIFICATE HOLDER CANCELLATION 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. Manashi Mukherjeet.rx 34+,�.,cE..w La. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100129 LOC#: Morristown ACOOR" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,INC SIEMENS INDUSTRY,INC BUILDING TECHNOLOGIES POLICY NUMBER 1000 DEERFIELD PARKWAY BUFFALO GROVE,IL 60089 CARRIER NAIC CODE I EFFECTIVE DATE: ADDITIONAL REMARKS 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 NON- 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. $1,000,000 PROFESSIONAL LIABILITY IS INCLUDED UNDER THE GENERAL LIABILITY POLICY. 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) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TC2J—CAP-744OL34A—TIL-18 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION 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.B., 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 "loss" 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 clesig- We waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 0215 (D 2015 The Travelers Indemnity company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. HDU GLOBAL INSURANCE COMPANY MANUSCRIPT BNDORSEK8ENT#32 Policy Number Named Insured GLD11101-10 SIEMENS CORPORATION Policy Period: |nception(K8-D-Y) Expiration(K8-O-Y) Effective Date and Time of Endorsement 10'01'2018 10'01-2019 1D-01'2O18 12:01 a.rn. Standard Time at Address of the Insured. This Endorsement Changes The Polioy. Please Read It Carefully. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Form Who is on insured is amended to include as an additional insured any person whom you are required tdd 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' oaused, in whole or in part, by: 1. Your acts or omissions; or 2. The eoto 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 ofthe Limits ofInsurance provided toyou inthis policy,orthe limits ofinsurance you are required to provide inthe 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 wTiften 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 provided that the additional insured is a Named Insured under such other insurance. This endorsement shall prevail over additional insured endorsements that may apply under this policy unless required otherwise inthe written agreement. 1177 Authorized Representative All terms and conditions ofthe policy remain unchanged. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENOORSEK8ENTVVHENISSUED AFTER THE POLICY IS WRITTEN. POLICY NUMBER: GLD11101-10 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 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 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 ❑ TRAVELERS!' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)- POLICY NUMBER: (TC2JUB-8049x50-8-18) 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. DATE OF ISSUE: 09-07-18 STASSIGN: