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HomeMy WebLinkAbout564006 SCHNEIDER ELECTRIC USA INC - INSURANCE CERTIFICATE (2)SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Schneider Electric Buildings, LLC� Schneider Electric USA, Inc. � Schneider Electric Motion USA, Inc.� ASCO Power Technologies, L.P. (Named Insured as of 11/1/2017)�� Telvent USA, LLC� 2 2 Pro-Face America, LLC� Pelco, Inc.� Boston Schneider Electric IT America Corp.� Schneider Electric IT USA, Inc.� Schneider Electric IT Mission Critical Services, Inc.� Schneider Electric Systems USA, Inc. (formerly Invensys Systems, Inc.)� �� �� Schneider Electric IT Corporation � ADDITIONAL NAMED INSUREDS INCLUDE THE FOLLOWING:� Certificate of Liability Insurance Schneider Electric Grid Automation, Inc.� CN102662751 Renewable Choice Energy Inc. (Included as Named Insured as of 1/13/2017 )� Schneider Electric Buildings Critical Systems, Inc.� Schneider Electric Power Services, Inc.� Schneider Electric Solar Inverters USA, Inc.� Schneider Electric Engineering Services, LLC� Veris Industries, LLC� Applied Instrument Technologies, Inc.� MARSH USA INC.� 200 North Martingale Road, Suite 1000� Schneider Electric Holdings, Inc.� Schaumburg, IL 60173 Summit Energy Services, Inc.� ASCO Power Services, Inc. (Named Insured as of 11/1/2017)� 25 Schneider Electric Buildings Americas, Inc.� (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Manashi Mukherjee NYC-010433042-01 SIR of Marsh USA Inc. Attn: Boston.CertRequest@marsh.com | Fax: 212-948-4377 N PHYSICAL DAMAGE 2 A CYBER 01/01/2019 02/19/2019 1,135,670 5,000,000 Evidence of coverage 215 North Mason St. Fort Collins, CO 80522 City of Fort Collins LIMIT SROBE 19445 01/01/2020 99 HIGH STREET MARSH USA INC. BOSTON, MA 02110 200 North Martingale Road, Suite 1000 Schneider Electric Holdings, Inc. Schaumburg, IL 60173 64738469 Attn: Gerry Paul X X National Union Fire Insurance Company