Loading...
HomeMy WebLinkAbout498989 XYLEM WATER SOLUTIONS USA INC - INSURANCE CERTIFICATE (3)ACDATE fMMIDDIYYYY) RfO 0® CERTIFICATE OF LIABILITY INSURANCE 10/312019 . THIS CERTIFICATE IS ISSUm 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.. If SUBROGATION IS WAIVED, this certificate does not confer PRODUCER Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 1 DO36 INSURED. water Solutions USA, Inc. Leopold Products 227 South Division Street Zelieriople, PA 16063 is an AULI1 I IUNAL INsuKtu, Tni :t to the terns and conditions of to the certificate holder in lieu of i must have ADDITIONAL INSURED provisions or be endorsed. certain policies may require an endorsement. A statement on Co. COVERAGES CERTIFICATE NUMBER: 14YC-010126267-14 REVISION NUMBER: 8 NAIL a 19445 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 jOR 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. tLTR TYPE OF INSURANCE D POLICY NUMBER MM/DDY/YYYY MMID f EXP LIMITS B X COMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR GL6862456 10/312019 10/31/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea ommnce $ 1,000,000 MED EXP (Any oneperson) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY EJECT LOC OTHER GENERAL AGGREGATE $ 2,000,000 X PRODUCTS - COMP/OP AGG $ 2.000,000 SIR: $1,000,000 $ B B B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-0NMED AUTOS ONLY AUTOS ONLY CA5320316(AOS) CA 532031 CA 5320318 (VA) (MA) 10/31/2019 10131/2019 10/312019 10/312020 10/312020 10/31/2020 COMBINED SINGLELIMIT Es accident $ $000000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per atxident $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER(EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Myyandatory In NH) DESCRIPTION TIOF OPERATIONS below NIA SEE ACORD101 - -10/31/2020 - -X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional City of Fort Collins is included as additional insured (except Workers Compensation Remits Schedule, may be aNactied f mom space Is required) as required by written contact. City of Fort Collins I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fort Collins, CO 80522 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Lauren Giagrande 9)1888-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN108453421 _ LOC#: .New York ACCMOP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA, Inc. Xylem Water Solutions USA, Inc. Leopold Products 227 South Division Street PouaY NUMBER Zelienopte, PA 16063 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insu WORKERS COMPENSATION: CARRIER: NEW HAMPSHIRE INSURANCE COMPANY POLICY: WC 020608516 (ADS) CARRIER NEW HAMPSHIRE INSURANCE COMPANY POLICY: WC 020608517 (IL, KY, NC, NH, LIT, VT) CARRIER NEW HAMPSHIRE INSURANCE COMPANY POLICY: WC 020608518 (NJ, PA) CARRIER NEW HAMPSHIRE INSURANCE COMPANY POLICY: WC 020608519 (MA, OH, WA, WI, WY) CARRIER: AMERICAN HOME ASSURANCE POLICY: WC 020608520 (CA) CARRIER ILLINOIS NATIONAL INSURANCE COMPANY POLICY: WC 020608521(FL) CARRIER NEW HAMPSHIRE INSURANCE COMPANY POLICY:. WC 020608522 (AZ, VA) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD