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HomeMy WebLinkAboutCORRESPONDENCE - RFP - 8777 GEOGRAPHIC INFORMATION SYSTEM EDITING TOOLS AND GRAPHIC WORK DESIGN SOLUTION (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: WC 014649569 -(AK, AL, AR, CO, CT, DC, DE, GA, HI, IA, ID, IN, KS, LA, ME, MD, MI, MN, MO, MS, MT, NE, NM, NV, NY, OK, OR, RI, SC, SD, TN, TX, WV) - New Hampshire Schneider Electric Buildings, LLC� WC 014649571 (CA) - American Home Assurance � Schneider Electric USA, Inc. � SELF-INSURED RETENTION: $2,000,000� WC 014649575 (FL) - New Hampshire Insurance Company � Schneider Electric Motion USA, Inc.� ASCO Power Technologies, L.P. � � Telvent USA, LLC� LIMITS: EACH ACCIDENT: $3,000,000 / DISEASE-POLICY LIMIT: 3,000,000 / DISEASE-EACH EMPLOYEE: $3,000,000� 3 � WC 014649576 (MA, ND, OH, WA, WI, WY) - New Hampshire Insurance Company� POLICY PERIOD: 01/01/19 - 01/01/20� � 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 )� POLICY NUMBERS, STATES, AND CARRIERS:� Schneider Electric Buildings Critical Systems, Inc.� Insurance Company � Schneider Electric Power Services, Inc.� Schneider Electric Solar Inverters USA, Inc.� Schneider Electric Engineering Services, LLC� PUERTO RICO: WC IS PURCHASED THROUGH THE STATE FUND AS PUERTO RICO IS MONOPOLISTIC� **ADDITIONAL WORKER'S COMP POLICIES**� TrendPoint Systems, Inc.� Veris Industries, LLC� POLICY NUMBER: 6583126� OHIO ONLY EXCESS WORKERS COMP:� Applied Instrument Technologies, Inc.� 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: 3 3 Boston the Certificate Holder shall impose no obligation or liability of any kind upon the insurer or its agents or representatives.�� Schneider Electric Holdings, Inc. has agreed that, within 30 days after receipt of notice of cancellation of the insurance policies referenced above from the applicable insurers, � does not alter or amend any coverage, it will not extend any policy cancellation date and it will not negate any cancellation of the policy. Failure to provide a copy of such notice to Schneider Electric Holdings, Inc. or its designee will send a copy of such notice to the Certificate Holder of this Certificate. Such notice is not a right or obligation within the policies, it Certificate of Liability Insurance CN102662751 MARSH USA INC.� 200 North Martingale Road, Suite 1000� Schneider Electric Holdings, Inc.� Schaumburg, IL 60173 25 � MARSH USA INC.� � Umbrella Liability follows the underlying on additional insured and waiver of subrogation status pursuant to policy terms, conditions, and exclusions.� 200 North Martingale Road, Suite 1000� Schneider Electric Holdings, Inc.� Schaumburg, IL 60173 Summit Energy Services, Inc.� WC 014649573 (AZ, IL, KY, NC, NH, NJ, PA, UT, VA, VT) - New Hampshire Insurance Company � ASCO Power Services, Inc. � POLICY PERIOD: 01/01/19 - 01/01/20� 25 CARRIER: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA � 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 B 5,000,000 3629879 Manashi Mukherjee Additional WC/EL policies are shown NYC-010428369-02 5,000,000 5,000,000 X 01/01/2019 41343 5,000,000 POLICY IS CLAIMS MADE of Marsh USA Inc. Attn: Boston.CertRequest@Marsh.com | Fax: 212-948-4377 N 01/01/2019 X Contractual Liability 01/01/2019 A 2 01/01/2020 01/01/2019 A 01/01/2020 1921780 (AOS) PROFESSIONAL C 5,000,000 5,000,000 on the following page 23841 HDI Global Insurance Company 5,000,000 X A X 02/15/2019 01/01/2019 5,000,000 City of Fort Collins is included as additional insured with respect to General Liability and Auto Liability per the endorsement(s) attached. X 01/01/2020 215 North Mason St. Fort Collins, CO 80522 City of Fort Collins X 1921779 (VA) A New Hampshire Insurance Co. EACH CLAIM / AGGREGATE 5,000 01/01/2020 5,000,000 CUD11986-07 01/01/2020 E&O LIABILITY 1921781 (MA) 5,000,000 19445 5,000,000 SROBE 5,000,000 01/01/2020 014649569 (AOS) 99 HIGH STREET MARSH USA INC. X BOSTON, MA 02110 200 North Martingale Road, Suite 1000 Schneider Electric Holdings, Inc. Schaumburg, IL 60173 X X 04-587-10-64 01/01/2019 Attn: Gerry Paul X X 01/01/2019 A 01/01/2020 National Union Fire Ins Co Pittsburgh PA