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HomeMy WebLinkAbout504949 SIEMENS INDUSTRY INC - INSURANCE CERTIFICATE (8)AC �® DATE(MMIDD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 06/06/2018 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: 445 SOUTH STREET (a�NNo. Ext): (A No): MORRISTOWN. NJ 07960-6454 E-MAIL 100129-MOBI--17/18 MOBI Harper 0704 NOC60 INSURER A: HDI Global Insurance Company 41343 INSURED INSURER B : The Travelers Indemnity Company 25658 SIEMENS MOBILITY INC. 170 WOOD AVENUE SOUTH INSURER C : Travelers Property Casually Co. of America 25674 ISELIN, NJ 08830 INSURER D : The Charter Oak Fire Insurance Company 25615 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-009539946-18 REVISION NIIMRFR: 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. INPOLICY TR R TYPE OF INSURANCE ADDL INSD S VD POLICY NUMBER EFF MM DD/YYYY POLICY EXP MM/DDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLD1110109 10/01/2017 10/01/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DA AGE TO TED PREMISES Eaocicurrrence $ 1,000,000 MED EXP (Any one person) $ 100,000 _ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 10,000,000 X POLICY ❑PRO JECT LOC PRODUCTS - COMP/OP AGG $ INCL. $ OTHER C AUTOMOBILE LIABILITY TC2JCAP7440L34A17 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ N/A ANY AUTO OWNED ASCHEDULED AUTOS ONLY UTOS X BODILY INJURY (Per accident) $ NIA X PROPERTY DAMAGE Per accident $ NIA HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ D B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N 11 TC20UB8049X50817(ADS) TRKUB8049X51A17 (AZ, MA, OR & WI) TWXJUB7440L33817 OH & WA ( ) 10/01/2017 10/01/2017 10/01/2018 10/01/2018 10/01/2018 X PER orH- STATUTE ER E.LEACHACCIDENT $ 1,000,000 E L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below $500K LIMIT / $500K SIR"""" E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES. SUCH INSURANCE AS IS AFFORDED BY THE ADDITIONAL INSURED ENDORSEMENT SHALL APPLY AS PRIMARY INSURANCE & OTHER INSURANCE MAINTAINED BY THE CERTIFICATE HOLDER SHALL BE EXCESS ONLY & NOT CONTRIBUTING WITH INSURANCE PROVIDED UNDER THIS POLICY. WAIVER OF SUBROGATION IS EFFECTUAL. $1,000,000 PROFESSIONAL LIABILITY IS INCLUDED UNDER THE GENERAL LIABILITY POLICY, IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER UP TC 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: ED BONNETTE, C.P.M., CPPB, BUYER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 NORTH MASON STREET 2ND FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. FORT COLLINS, CO 80524 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _3V[ cLuork►•:d ., to ,,� c� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD