Loading...
HomeMy WebLinkAboutXYLEM WATER SOLUTIONS USA INC - INSURANCE CERTIFICATEACOR" CERTIFICATE OF LIABILITY INSURANCE o 080019DmYY) 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 Marsh USA, Inc. 1166 Avenue of the Americas CONTACT Lauren Gian rande NAME: 9 PUVCHONNo,EEtI, (212) 345 6000 AIC Not: ADORIEss: Lauren.Giarlgrande@marsh.com New York, NY 10036 INSURE S AFFORDING COVERAGE NAIC• INSURER A : AGE American Insurance Company 22667 CN108453421-STND-GAWex-18-19 INSURED Xylem Water Solutions USA, Inc. INSURER B : ACE Fire Undenvdters Ins. Co. 20702 INSURER C : Indemnity Insurance Company of North America 43575 Leopold Products INsuRER D : Allianz Global Risks US Insurance Company 35300 227 S Division St. Zelienople, PA 16063 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: NYC-010687235-02 REVISION Nt1MBFR- 2 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. LTRR TYPE OF INSURANCE ADDL SUER POLICY NUMBER CY FFF MM/DDNYYY MM DDYNM LIMITS D X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 111 OCCUR USLOO107118 10/31/2018 10/3112019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000.000 MED EXP oneperson) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY1:1 JE'CT- LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 SIR: $1,000,000 It A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ISA H25272754 10/31/2018 1012112010 COMBINED SINGLE LIMIT Ea accident $ 3,000,000 X BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ 4 AGGREGATE $ DID RETENTION$ $ C B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, oesmbe under DESCRIPTION OF OPERATIONS below N / A WLR C65437065 (ADS) SCF C65437107 (WI) WLR C65437028 (CA, MA, OR) 10/31/2018 10/31/2018 —iU/Ti/2019 10/312019 10131/2019 X STATUTE ER E.L. EACH ACCIDENT $ 2 D00 000 E L. DISEASE - EA EMPLOYEE $ 2,000.000 I E.L. DISEASE - POLICY LIMIT $ 2,000,000 -F DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is Included as additional insured (except Workers Compensation) as required by written contract. City of Fort Collins 215 N Mason St, 2nd Floor PO Box 580 Fat Collins, CO 80522 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. Lauren Giagrande c3a� jQ d P ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD