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HomeMy WebLinkAbout504949 SIEMENS INDUSTRY INC - INSURANCE CERTIFICATE (2)-1 ® ACORL� CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 09/2612014 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. FAx PXC NE A/C No: E-MAIL ADDRE MORRISTOWN, NJ 07960&154 INSURER(SI AFFORDING COVERAGE NAIC0 INSURER A:HDI-Geding Annerim Insurance Company 41343 100129-MOBI-14115 MOBI HARPE 0704 NOC60 INSURED SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION INSURER B : The Travelers Indemnity Company 25658 INSURER C : The Chanel Galt Fire Ireumna Company 25615 INSURER D : Travelers Property Casualty Co. of ADlerica 25674 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 600804513 INSURER E : INSURER F COVE RA GES CFRTIFICATF NLIMRFR- NYC-006404634-10 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 ADDL UBR POLICY NUMBER MM/DDY IYYYY MA)DIYYYY1 LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR GLDIIIO106 10101/2014 10/01/2015 EACH OCCURRENCE $ 1,000.000 RENTED PREMISES Ea o=rrence $ 1,000,000 MED EXP Any one S 100,000 PERSONAL S ADV INJURY $ I,000,000 GENERAL AGGREGATE $ 10,000.000 GENL AGGREGATE X POLICY LIMIT APPLIES PER. PRO- MLOG JECT PRODUCTS - COMP/OP AGG $ INCL. $ D AUTOMOBILE LIABILITY X ALL OWNED SCHEDULED IXX ANY AUTO AUTOS UTOS X NON -OWNED HIRED AUTOS AUTOS TC2JCAP7440L34AI4 10/01/2014 10101/2015 COMBINED SINGLE LIMIT Ea accident 2000000 BODILY INJURY (Per peon) S WA BODILY INJURY (Par accident) $ WA PROPERTYOAMAGE Per arrJdanl $ WA $ UMBRELLA LUAS EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTIONS $ C B D WORKERS COMPENSATION AND EMPLOYERS' ANY PROPRIETORLIABILITY TOR /PARTNER/EXECUTIVE YIN OFFICEWMEMBER EXCLUDED? (Mandatory In NH) IfrS descnta under DESCRIPTION OF OPERATIONS Eelow NIA TC20UB744OL271 14 (ADS) TRKUB7440L28314 (AZ, MA, OR 8 WI) TWXJUB744OL33814 (OH ( ) —$500K LIMIT/$500K SIR"" 10101I2014 10101I2014 1010112014 WOU201$ 10101Y2015 10A)112015 VICSTAru- oTH- E. L. EACH ACCIDENT S 1,000,000 E.LDISEASE-EAEMPLOYE $ 1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) RE: JOB NO. N/A SEE ATTACHED CERTIFICATE HOLDER CANCELLATION 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 Q1AOOh+- �}1A,.AAc..naJ� 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 100129 LOC #: Morristown AGENCY MARSH USA, INC. POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE Page 2 of 2 NAIC CODE NAMED INSURED SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL M94513 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 UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES. 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. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD a►co CERTIFICATE OF LIABILITY INSURANCE °o� 6014 "' 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 endorsemen s . PRODUCER MARSH USA, INC. 445 SOUTH STREET CONTACT NAME: PHONE FAX MC No: E-MAIL ADDRESS: MORRISTOWN, NJ 079W&54 INSURE S AFFORDING COVERAGE NAIC0 INSURER A: Liberty Mutual Insurance Company 23043 100129-FED-CRIME-14115 MOBI HARPE INSURED SIEMENS INDUSTRY INC. INCLUDING INSURER B : MOBILffYIITS DIVISION C UR 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089.4513 FINSUR,ER URURER F COVE GES CERTIFICATE NUMBER: NYC-0064046%10 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 ADDL US POLICY NUMBER EFF MWDDPOLICY/YYYY EXP MWDDYIY YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA N PREMISES Ea occurren e $ MED EXP (My one parson)S CLAIMS -MADE F—IOCCUR PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ 17 POLICY PRO- El LOC JECT AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT Ea acdden BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accidem) $ ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS PPROPEo�mDAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS U,IM CLAIMS -MADE DED RETENTIONS f WORN ERSCOMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNER/EXECUTIW YIN N E.L. EACH ACCIDENT f OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE- EA EMPLOYE E E.L. DISEASE- POLICY LIMIT $ If yes, desuibe u er DESCRIPTION OF OPERATIONS bol A FIDELITYIEMPLOYEE TC2JFID7440L39914 101012014 10N12015 5,000,000 DISHONESTY DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Addmonal Remark, Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AT IN: 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 Mukhegee.Ae�aw�e-a- ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ,aco o® CERTIFICATE OF LIABILITY INSURANCE D0912612014 n 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 endorsemen s . PRODUCER MARSH USA, INC. 445 SOUTH STREET MORRISTOWN, NJ 07960,5454 CONTACT NAME: PHONE FAX AIc No: EMAIL ADDR INSURE S AFFORDING COVERAGE NAIC0 INSURER A,HDI-Geding America lnsuranCe Company 41343 100129-MOSI-14/15 MOBI Harper 0704 NOC60 INSURED SIEMENS INDUSTRY INC. INCLUDING: MOBILITY DIVISION 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 6M"513 INSURER B : The Travelers Indemnity Company 25658 INSURER C The Charier Oak Fire Insurance Company 25615 I INSURER D: Travelers Properly Casualty Co. of America 25674 INSUER E INSURRER F: COVERAGES CERTIFICATE NUMBER: NYC-006447212-10 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 OF INSURANCE WD­DLTYPE IN-- B POLICY NUMBER MIDDY EFF MWDDfYYV Y LIMITS A GENERAL LIABIUTY GLD1110106 10101/2014 10101/2015 EACH OCCURRENCE E 1.000,000 X COMMERCIAL GENERAL LIABILITY AMA ET RENTED PREMISES fE. ccaanence $ 1000000 MED EXP(My we person) S 100,000 CLAIMS -MADE Ifl OCCUR PERSONAL &ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 10,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGO $ INCL. $ X POLICYF—I PRO- LOC D AUTOMOBILE LIABILITY TC2JCAP7440L34A14 10101/2014 10/0112015 OMB DI SINGLE LIMIT IEa 2000000 BODILY INJURY(Per person) $ WA X ANY AUTO BODILY INJURY (Per ecci1W) $ WA X ALL OWNED SCHEDULED AUTOS TOS NOWOWMED X HIRED AUTOS X AUTOS PROPERTY DAMAGE era ¢ideM $ WA UMBRELLA LLAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LWB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION TC20UB744OL27114 (ADS) 1010112014 10/0112015 XwC STATU- oTH- B D AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIE%ECUTIVE Y/❑NN OFFICER/MEMBER EXCLUDED4 (Mandatory in NH) If es, descrihe under DESCRIPTION OF OPERATIONS Wow NIA TRKUB744OL28314 (AZ, MA, OR & WI) TWXJUB744OL.33814 OH & WA ( ) '""$SOOK LIMIT I $SOOK SIR""' 10101/2014 10101/2014 10/0112015 10/0112015 E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE $ 1'000,000 E L DISEASE -POLICY LIMIT 8 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES (Attach ACORD 101, Addlllonal Remarks Schedule, If more space Is required) THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES. 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 REWIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. CFRTIFICATF HTN nFR CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: ED BONNETTE, C.P.M., CPPB, 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 AUTNORD:ED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherlee �iaLKooy: ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD