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Home My WebLink About504949 SIEMENS INDUSTRY INC - INSURANCE CERTIFICATE (5)ACOR -I a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/12/2017 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 MARSH USA, INC. 445 SOUTH STREET CONTACT NAME: PHONE FAX A/C No): JAlC. No. Ext); ('C' E-MAIL ADDRESS: MORRISTOWN, NJ 07960-6454 INSURERS AFFORDING COVERAGE NAIC # INSURER A: HDI Global Insurance Company 41343 100129-MOBI--17/18 MOBI Harper 0704 NOC60 INSURED SIEMENS INDUSTRY, INC. MOBILITY DIVISION INSURER B : The Travelers Indemnily Company 25658 INSURER C : Travelers Property Casualty Co. of America 25674 INSURER D : The Charter Oak Fire Insurance Company 25615 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089-4513 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-009539946-16 REVISION NUMBER: 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 A X COMMERCIAL GENERAL LIABILITY GLD1110109 10/01/2017 10/01/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FqOCCUR DAMA E T RENTED PREMISES Ea occurrence $ 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 PRODUCTS - COMP/OP AGG $ INCL. X PRO ❑ LOC POLICY ElJECT $ OTHER. C AUTOMOBILE LIABILITY TC2JCAP74401_34A17 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ N/A X ANY AUTO BODILY INJURY (Per accident) $ N/A X OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ N/A 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? a (Mandatory in NH) N / A TC20UB8049X50817(AOS) TRKU68049X51A17 AZ, MA, OR & WI ( ) TWXJUB7440L33817 OH & WA ( ) 10/01/2017 10/01/2017 10/01/2018 10l01/2018 10/01/2018 H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below """" $500K LIMIT / $500K SIR"""" 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 CITY OF FORT COLLINS ATTN: ED BONNETTE, C.P.M., CPPB, BUYER 215 NORTH MASON STREET 2ND FLOOR FORT COLLINS, CO 80524 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. Manashi Mukherjee ,Av(uMN.c .0" V 7`Jtft5-ZU9b AUUKL) I:UKF'UKA I IUIV. All rlgnrs reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD