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HomeMy WebLinkAbout498989 XYLEM WATER SOLUTIONS USA INC - INSURANCE CERTIFICATE (5)® DATE (MMIDD/YYYY) �_. CERTIFICATE OF LIABILITY INSURANCE 08/15/2018 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 (Arc No, Ext): _ (A/C, No): New York, NY 10036 E-MAIL^ CN1 08453421 -STND-GAWex-1 7-18 INSURER A: ACE American Insurance Company 22667 INSURED INSURERS : ACE Fire Underwriters Ills. Co. 20702 Xylem Water Solutions USA, Inc. Leopold Products INSURER C : Indemnity Insurance Company of North America 43575 227 South Division Street INSURER D : Allianz Global Risks US Insurance Com ap ny 35300 Zelienople, PA 16063 - INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-010128267-08 RFVISION NIIMRFR: 8 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/DDIYYYY LIMITS D X COMMERCIAL GENERAL LIABILITY CGL2010272 10/31/2017 10/31/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR $ 1,000,000 —DAMAGE RENTED PREMISESS ( Ea occurrence PREMISES MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO❑LOC PRODUCTS -COMP/OP AGG $POLICY❑JECT 2,000,000 SIR: $1,000,000 $ OTHER A AUTOMOBILE LIABILITY ISA H09063742 10/31/2017 10/31/2018 COMBINED SINGLE LIMIT Ea accident) $ 2,000,000 X BODILY INJURY (Per person) _ $ ANY AlJTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS MADE DIED I I RETENTION $ $ C B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WLR C64619536 (AOS) SCF C64619548 (WI) WLR C64621695 CA, AZ, HI, MA, NM, ( 10/31/2017 10/31/2017 10/31/2018 10/31/2018 10/31/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT _ $ 2,000,000 E L DISEASE - EA EMPLOYEE $ 2,000,000 If yes describe under DESCRIPTION OF OPERATIONS below NV, OK, OR, VT, WA) E.L. 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. 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 © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD