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Home My WebLink About498989 XYLEM WATER SOLUTIONS USA INC - INSURANCE CERTIFICATE (7)® DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 10120/2017 THIS S 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). CONTACT PRODUCER NAME: -- Marsh USA, Inc. PHONE FAx 1166 Avenue of the Americas / s Ext1: a/c No New York, NY 10036 E-MAIL ADDRESS: 506636-STND-GAWex-17-18 INSURED Xylem Water Solutions USA, Inc Leopold Products 227 South Division Street Zelienople, PA 16063 INSURERS AFFORDING COVERAGE NAIC # A: ACE American Insurance Company 22667 B : ACE Fire Underwriters Ins. Co. 20702 c : Indemnitv Insurance Company of North America _ _ _ 43575 E: .111 n. n. 'o nc MCvleinAl IJIIMQ9=0- S GUVtKAUM0 a..V—n l-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 POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS D X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX OCCUR CGL20101272 10/31/2017 10/31/2018 EACH OCCURRENCE $ 1,000,000 DAMAZETOWENTED PREMISES Ea occurrence $ 1,0 MED EXP (Any one person) 10,000 $ 0,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ECTPRODUCTS X POLICY ❑ PRO- LOC GENERAL AGGREGATE $ 2,000,000 - COMP/OP AGG $ 2,000,000 SIR: $1,000,000 $ A OTHER: AUTOMOBILE LIABILITY ISA H09063742 10/31/2017 10/31/2018 --COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident)$ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR PER _ X STATUTE ERH C WLR C64619536 (AOS) 10/31/2018 DED I I RETENTION $ WORKERS COMPENSATION E.L. EACH ACCIDENT $ 2,000,000 B A AND EMPLOYERS' LIABILITY Y / N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A SCF C64619548 WI ( ) WLR C64621695 (CA. AZ, HI, MA, NM, NV, OK, OR, VT, WA) 10/31/2017 10131/2017 10/31/2018 10131/2018 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 El DISEASE -POLICY LIMIT $ 2,000,000 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. 11.3 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 c w�n�n r+/1o0f%0ATIf%kI All A-h+. ro .c on ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD