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Ac"R" CERTIFICATE OF LIABILITY INSURANCE r
<br /> ATE(MMIDDIYYYY)
<br /> �/ 1010212024
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> MARSH USA,LLC. NAME:
<br /> 445SOUTH STREET PHONE FAX
<br /> MORRISTOWN,NJ 07960-6454 E-MAIL A/C No
<br /> ADDRESS:
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> CN102147003-RAM-PROF-24/25 4433 WHITE NOC60 INSURER A: HDI Global Insurance Comr)any 41343
<br /> INSURED SIEMENS INDUSTRY,INC. INSURER B: Travelers Prove ProveNy Casualty Go.of America 25674
<br /> 1000 DEERFIELD PARKWAY INSURER C: Travelem Casualty&Surety Compary19038
<br /> BUFFALO GROVE,IL 60089-4513 INSURER D:
<br /> INSURER E:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: NYC-010974624-10 REVISION NUMBER: 12
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR I ADDL SUBR
<br /> LTR TYPE OF INSURANCE WVpPOLICY NUMBER MMIDDY� MMIDDY� LIMITS
<br /> A X COMMERCIALGENERALLIABILITY GLD1110116 10/01/2024 10/01/2025 EACH OCCURRENCE S 1,000,000
<br /> CLAIMS-MADE X❑OCCUR DAMAGE (RENTED
<br /> PREMISES Ea occurrence)
<br /> ccurrence) $ 1,000,000
<br /> MED EXP(Any one person) $ 100,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000
<br /> X POLICY❑jE O- LOG PRODUCTS-COMPIOP AGG $ INCL
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-TIL-24 10/01/2024 10101/2025 COMBINED tSINGLE LIMIT g 2,000,000
<br /> 1xx
<br /> ANY AUTO BODILY INJURY(Per person) $ N/A
<br /> OWNED SCHEDULEDBODILY INJURY Per accident $ NIA
<br /> AUTOS ONLYN
<br /> AUTOS ( )HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $ NIA
<br /> S
<br /> A X UMBRELLA X OCCUR CUD1110216 10/01/2024 10/01/2025 EACH OCCURRENCE S 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
<br /> DED I I RETENTION$ $
<br /> B WORKERS COMPENSATION UB-8P83929A-24-51-K(AOS) 10101/2024 10/01/2025 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> C ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N UB-SP79233A-24-51-R(AZ,MA,WI) 10/01/2024 10101/2025
<br /> OFFICERIMEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> B (Mandatory in NH) TWXJUB-7440L338-TIL-24(OH) 10/0112024 10/01/2025 EL.DISEASE-EAEMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below .............$500K LIMIT/$500K SIR"°',,,,,,,, E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A PROFESSIONAL LIABILITY EOD5618805 1110112124 10/01,2125 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:ALL OPERATIONS
<br /> SEE ATTACHED
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> ATTN:RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 CIVIC CENTER PLAZA,4TH FLOOR ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> SANTA ANA,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA LLC
<br /> ACORD 25(2016/03) The ACORD name and logo are registered APPROVED
<br /> By Cynthia Mora at 11:43 am, Nov 05, 2024
<br />
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