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HomeMy WebLinkAbout498989 XYLEM WATER SOLUTIONS USA INC - INSURANCE CERTIFICATE (6)Ago CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/21 /2018 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 CONTACT Marsh USA, Inc. NAME: _ PHONE FAX 1166 Avenue of the Americas (A/C. NQ EXW. New York, NY 10036 E-MAIL ADDRESS: INSURER(SI AFFORDING COVERAGE NAIC # CN 108453421-STND-GAWex-17-18 INSURED Xylem Water Solutions USA, Inc. Leopold Products 227 South Division Street Zelienople, PA 16063 INSURER A: ACE American Insurance D: cnVGRARFQ r`FRTIFIr_ATF NI IMRFR• NYC-010128267-07 RFVISION Nt1MRFR: 7 22667 20702 43575 35300 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 SUBR POLICY NUMBER FOLICY EFF YYYY POLICY X LIMITS D X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE xJ OCCUR CGL2010272 10/31/2017 10/31/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RE PREMISES Ea occuErrence $ _ _ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER PRO - POLICY PRO JECT ❑ LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000X SIR' $1,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY ISA H09063742 10/31/2017 10/31/2018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE AGGREGATE $ HCLAIMS-MADE $ DED RETENTION $ $ C B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNERIEXECUTIVE OFF ICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WLR C64619536 (AOS) SCF C64619548(WI) WLR C64621695 (CA, AZ, HI, MA, NM, NV, OK, OR, VT, WA ) 10/31/2017 10/31/2017 10/31/2018 10/31/2018 10/31/2016 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 L L - DESCRIPTION OF OPERATIONS / LOCATIONS / 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 CERTIFICA I t City of Fort Collins PO Box 580 Fort 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 cfr�rvQ�r�ca.r ncl_n ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD