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HomeMy WebLinkAbout491581 SIEMENS INDUSTRY INC - INSURANCE CERTIFICATE (2)A� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDYYYY) 0912712013 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 MARSH USA INC. 445 SOUTH STREET CONTACT NAME: _ PHONE PAIC E'AUIL ADDRE ' MORRISTOWN, NJ 07960-6454 INSURERSINSURERSI AFFORDING COVERAGE HAY: a INSURER A: Lb" Mulual insurance Company 23043 100129-FED-CRIME-13114 MOBI HARPE INSURED SIEMENS INDUSTRY INC. INCLUDINGMOBTYATS DIVISIONo 0I5 1 INSURFAB: INSURER C: INSURER D: O 1000 D ERF ELLD PARKWAY BUFFALO GROVE, IL 60089-4513 INSURER E INSURER F : rnvcowr_cc CERTIFICATE MIIMEI NYGfinmmfi50-09 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 LTR TYPE OF INSURANCE 015wUsIll POLICY NUMBER POLICY EFF POLICY EXP LIMAS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—IOCCUR EACH OCCURRENCE S DAMAGE E MI E rt $ MED EXP (Any one non) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY LIMIT APPLIES PER: Pfl0- LOC PRODUCTS-COMP/OP AGG S S AUTOMOBILE LUIBILM ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY(ParplKaon) S BODILY INJURY(PW aockW#) $ PROPERTY DAMAGE P nt $ $ UMBRELLA UAS EXCESS DAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED7 (Mandatory in NH) "yes describe under DESCRIPTION OF OPERATIONS WIcw N/A WCSTATU- OTH- E.L. EACH ACCIDENT S E.L DISEASE -EA EMPLOYE S E.L DISEASE -POLICY LIMIT $ A FIDELITYIEMPLOYEE DISHONESTY TRJTID-744OL399 1=112013 10101/2014 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (AHach ACORO 101, Additional Remarks Schedula, if moro apace b rayWr•d) rcorrorwTc unt ncR CANCFLLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: ED BONNETTE, C.P.M., CPPG, BUYER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 NORTH MASON STREET 2ND FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80524 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ® 1988-2010 ACORU CORPORATION. ION. All rights rese"eci. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD MARSH To: To Whom It May Concern Date: September 25, 2013 From: Marsh CSS Subject: Siemens Corporation Certificates of Insurance 2013 - 2014 Policy Year Marsh USA Inc. 11011 Lakalina Blvd., Bldg 1, Su no 200 Austin, TX 78717 512 342 4400 Fax 212 948 0622 4siomenscs g@marsh. corn As a Siemens Corporation Certificate Holder, please find attached your company's renewal certificate for the 10/1/2013 — 10/1/2014 policy period. If you do not require this Certificate of Insurance, please advice by marking "delete" on the certificate and returning it via email (nisiemens.csg@marsh.com) or fax to (212) 948 0622. Best regards, Marsh CSS 14 MU h 6 btl . Cnmpan POLICYNUMBER: GLD11101-05 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anizatio s Locations Of Covered Operations ANY PERSON OR ORGANIZATION REQUIRED BY ALL LOCATIONS WHERE THE INSURED IS WRITTEN CONTRACT PERFORMING ONGOING OPERATIONS FOR AN ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(.$) or organization(s) shown in the Schedule, 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; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or Z That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: TC2J-CAP-7440L34A-TIL-13 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident', provided that the "accident' arises out of operations contem- plated by such contract. The waiver applies only to the person or organization designated in such contract. CA T3 40 02 99 Page 1 of 1 POLICY NUMBER: GLD11101-05 COMMERCIAL GENERAL LIABILITY C G 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 in the Declarations. The following is added to Paragraph 8. Transfer Ot 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 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ A� o® CERTIFICATE OF LIABILITY INSURANCE UATE12013 YYI 09127R013 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 MARSH USA, INC. 445 SOUTH STREET CONTACT NAME' PHONE FA% 1AIC, No. Eak NO), E-MAIL ADDRE MORRISTOWN, NJ 07960-6454 INSURERS AFFORDING COVERAGE NAICN INSURER A: Liberty Mutual Insurance Company 23043 1001 29-F ED-CRIME-1 3/14 MOBI Ha_Te_r_ _ INSURED SIEMENS INDUSTRY INC. INCLUDING, INSURER B : MOBILITY DIVISION INSURER C: INSURER D : 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60009-4513 INSURER E : _ INSURER F : Cf1VFRAGFS CERTIFICATE NUMBER_ NYC-00644722609 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. IL LTR TYPE OF INSURANCE i ADDL SLISR POLICY NUMBER PWDDDYOLICY FY POLICY EXP UMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0OCCUR EACH OCCURRENCE $ a n _ $ MED EXP (Any one ntan $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GENE AGGREGATE POLICY LIMIT APPLIES PER: 7 PRO- LOC PRODUCTS-COMP/OP AGG S $ AUTOMOBILE LIMILrry ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS PAUTOS COMBINED SINGLE LIMIT (EA =XNnII BODILY INJURY(PM Peocn) $-----_— BODILY INJURY (Per aocklent) S PROPERTY DAMAGE It S UMBRELLA LIRA EXCESS UAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILRY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDE09 (Mandatory In NH) Byes descnteunder DE SCRIPTION OF OPERATIONS EeIow NIA WCSTATU- OTH- EL. EACH ACCIDENT $ E.1- DISEASE - EA EMPLOYE $ EL. DISEASE -POLICY LIMIT $ A FIDELITY/EMPLOYEE DISHONESTY TRJ-FID-74401-399 10/0112013 10101/2014 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AWitio" Ramerka SeNedUle, It more aPaca M taRVhad) CITY OF FORT COLLINS ATTN: ED BONNETTE, C.P.M., CPPB, BUYER 215 NORTH MASON STREET 2ND FLOOR FORT COLLINS, CO BD524 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 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A� o® CERTIFICATE OF LIABILITY INSURANCE OATE/2013 YVY) 09/27/2013 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: It 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 MARSH USA, INC. 445 SOUTH STREET CONTACT NAME' PHONE FA% (A& A/C No MORRISTOWN, NJ 07960.6454 EAJAAIL INSURERS AFFORDING COVERAGE NAIC0 _ INSURER A:HDI-Gerlig America Insurance Company 41343 100129-MOBI--13114 MOBI HARPE 0704 NOC60 INSURED SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION INSURER e : Travelers Property Casualty Co. of America 25674 INSURER C: The Charter Oak Fire Insurane Company 25615 INSURER D : 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089-4513 -- -- - — - MURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-006404634-09 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. MR TR TYPE OF INSURANCE DL JwaPOLICYNUMBEp POLICY EFF ONTNT) POLICY EXP (MWDD(YYYYI LIMNS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR GLD1110105 10/0112013 1010712014 RRENCE $ 1'�'� TO RENTED $ 1'�'� ono Poison)S 100,000 &ADV INJURY rGENERAL $ 1,o04000 GGREGATE $ 10,000.000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PER: PROJPCT- LOC -COMP/OP AGO S INCL. $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED SAUTOS AUTOHIRED AUTOS N NON -OWNED Ix AUTOS TC2JCAP744OL34A13 101012013 10101/2014 COMBINED SINGLE LIMIT 2000000 BODILY INJURY (Per Pelson) $ WA BODILY INJURY(Per acoMant) $ NIA PROPERTY DAMAGE $ WA $ UMBRELLA LIAS EXCESS LIAR OCCUR CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ C B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If descrllm under DESCRIPTION OF OPERATIONS bebw NIA TC20UB744OL27113 0) TR1U87440L28313 (AZ, MA, OR & WQ TWXJUB7440L33813 (OH & WA) ""E500K LIMIT / E500K SIR"" 10/012013 10I012013 10101/2013 10/01/2014 101012014 101012014 X IWCSTATU-I I0L E.L. EACH ACCIDENT $ i•�•� E.L. DISEASE -EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMB 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks ScMdule, it more space is required) RE: JOB NO, N/A SEE ATTACHED CITY OF FORT COLLINS ATTN: ED BONNETTE, C.P.M., CPPG, BUYER 215 NORTH MASON STREET 2ND FLOOR FORT COLLINS, CO 80524 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-Mnrsn.nvr.< ®1 BBB-2010 ACUHU CUHPUHA I IUN. All rlgnts reserves. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100129 LOC 8: Morristown A4 0 ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED MARSH USA. INC. SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION 10DO DEERFIELD PARKWAY POLICY NUMBER BUFFALO GROVE, IL 60089-4513 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 CITY OF FORT COLLINS. THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT. 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. S1,000,000 PROFESSIONAL LIABILITY IS INCLUDED UNDER THE GENERAL LIABILITY POLICY. IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NONPAYMENT 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) u ZOOB Acortu GUKPUKA I IVIN. All rlgnts reserves. The ACORD name and logo are registered marks of ACORD MARSH Memo To: To Whom It May Concern Date: September 25, 2013 From: Marsh CSS Subject: Siemens Corporation Certificates of Insrruance 2013 - 2014 Policy Year Marsh USA Inc. 11011 Lakalina Blvd., Bldg 1, Suite 200 Austin, TX 78717 512 342 4400 Fax 212 948 0822 Ms iannens.csg@marsh.mm As a Siemens Corporation Certificate Holder, please find attached your company's renewal certificate for the 10/1/2013 — 10/1/2014 policy period. If you do not require this Certificate of Insurance, please advice by marking "delete" on the certificate and returning it via email (nisiemens.csg@marsh.com) or fax to (212) 948 0622. Best regards, Marsh CSS 14 Mar%h s W�ww C�rpw� POLICYNUMBER: GLD11101-05 COMMERCIAL GENERAL LIABILITY CG 20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) ANY PERSON OR ORGANIZATION REQUIRED BY WRITTEN CONTRACT Of Covered ALL LOCATIONS WHERE THE INSURED IS PERFORMING ONGOING OPERATIONS FOR AN ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law, and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 (0 Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: TC2J-CAP-7440L34A-TIL-13 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident', provided that the "accident" arises out of operations contem- plated by such contract, The waiver applies only to the person or organization designated in such contract. CA T3 40 02 99 Page 1 of 1 POLICY NUMBER: GLD11101-05 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 Co Insurance Services Office, Inc., 21308 Page 1 of 1 13 A� oCERTIFICATE OF LIABILITY INSURANCE DATEYYY) 09/2712013e '2013 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 endorsements . PRODUCER MARSH USA INC. 445 SOUTH STREET CONTACT NAME' PHONE FAX AAA EODRESS, MORRISTOWN, NJ 07960.6454 INSURE S AFFORDING COVERAGE NAICa INSURER A: HDI-Cerfng Anlerka Insurance Company 41343 100129-MO0I--13114 MOBI Haper 0704 NOC60 INSURED SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION Travelers Co. Of Amens INSURER e: ROPMY Ca ��Y me 25674 INSURER C: The Chaner Oak Fit Insurance Company 25615 INSURER D : 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089.4513 -- -- - INSURER E : INSURER F: —. ... COVERAGES CERTIFICATE NUMBER: NYC-006447212-09 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 LTA TYPE OF INSURANCE POLICY NUMBER POLICY Y POLICOY E% P LW" A GENERAL LIABILITY GLD1110105 10/0112013 10101/2014 EACH OCCURRENCE S 1,0D0,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR DAMAGE occurrence) $ 1,000,000 MED EXP (Any one neon S 100,000 PERSONAL & ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO S INCL. $ X I POLICY F1PRO- LOC B AUTOMOBILE LIABILITY TC21CAP7440L34A13 1010112013 101012014 COMBINED SINGLE LIMIT 2000000 BODILY INJURY (Per Pembn) S NIAALL ANY AUTO BODILY INJURY(Per accident) S NIA OWNED SCHEDULED AUTOS X TOS NON -OWNED HIRED AUTOS AUTOS Ix PROPERTY DAMAGE $ NIA $ UMBRELLA UAB OCCUR EACH OCCURRENCE S I AGGREGATE $ EXCESS Lu1B CLAIMS -MADE DELI I I RETENTION $ C WORKERS COMPENSATION T 20UB744OL27113(ADS) 10/01/2013 101011 14 XWC STATu- OTH• B B AND EMPLOYERS' LIABILITY N ANY PROPRIETORIPARTNEWEXECUTIVE YIN ORPoCE ory in N R ExcLUDEDt a (Mendalory in NH) NIA TRJUB7440L2a3l3 (AZ, MA OR & WI) TWXJUB7440L33813 (OH & WA) 10/0112013 10/0112073 I N112014 1010112014 E.L. EACH ACCIDENT 1'000.000 $ E.L. DISEASE -EA EMPLOY S 1.000,000 E.1 DISEASE - POLICY LIMIT S 1.000,000 If yes. describe under DESCRIPTION OF OPERATIONS below "'SSDOK LIMIT / MK SIR"' DESCRIPTION OF OPERATIONS / LOCATIONS / VM41CLES (AHeIM ACORD 101, Addirio" fbmarkc Schedule, H more SPMle It requlrad) THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT. 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. $1,000,000 PROFESSIONAL LIABILITY IS INCLUDED UNDER 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. CITY OF FORT COLLINS ATTN: ED BONNETTE, C.P.M., CPPB, BUYER 215 NORTH MASON STREET 2ND FLOOR FORT COLLINS, CO 80524 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 Mamh USA Inc. Manashi Mukherjee-T'LcLv�aoti- 01968-201D ACUKL) L:UHYUHAI II All rlgnts reserVea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD