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CERTIFICATE OF LIA
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITL
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of t
<br />this certificate does not confer rights to the certificate holder In lieu of c
<br />PRODUCER
<br />MARSH USA, INC.
<br />446 SOUTH STREET
<br />MORRISTOWN, NJ 07960.6464
<br />100120-811--18/19
<br />INSURED
<br />SIEMENS INDUSTRY, INC.
<br />1000 DEERFIELD PARKWAY
<br />BUFFALO GROVE, IL 60089-4513
<br />COVERAGES
<br />SIL ANDRI NOC60
<br />CERTIFICATE NUMBER:
<br />F MZi36;iYYy)
<br />BILITDATE Y INSURANCE
<br />1 09119/2018
<br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />TE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
<br />)ollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />to policy, certain policies may require an endorsement. A statement on
<br />Lich endorsement(s).
<br />75WTACT ............
<br />POLICY EFF
<br />(MMIDDtYYYY)
<br />PHONEFAX
<br />A/C. No. Ext): WC, No):
<br />-MAIL
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE El OCCURD
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL III
<br />INSURER A: HDI Global Insurance Comllun
<br />41343
<br />-INSURER 8: Travelers Propel Casualty Co. of America _T5674
<br />EACH OCCURRENCE
<br />INSURER 0: The Travelars Indemn Compal
<br />25658
<br />$ 1,000,000
<br />_RBgMLSE$
<br />MED EXP (Any one person)
<br />INSURER D:
<br />INSURER E:
<br />INSURER t: ...... .... ... ............ - - ------
<br />12 F0111 [I t0kyl6fl#11 I I L1117d 111] 913
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED 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
<br />LTR
<br />.. .... - --_
<br />TYPE OF INSURANCE
<br />INSP,
<br />W P,
<br />0 toy NUMBER
<br />L10
<br />POLICY EFF
<br />(MMIDDtYYYY)
<br />POLICYEXP
<br />(MMIDDtYYYY)
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE El OCCURD
<br />GLD11101-10
<br />10/01/2018
<br />10/0112019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A M AG 11 T 0 1 EWTED"
<br />Ea occur a,)Qa)
<br />$ 1,000,000
<br />_RBgMLSE$
<br />MED EXP (Any one person)
<br />$ 100,000
<br />& ADV INJURY_
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO. [_1
<br />1:1 PRO- LOO
<br />_PERSONAL
<br />GENERAL AGGREGATE
<br />$ 10,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ INCL
<br />COMBI NiT6T_1NGCE_LIMIT_'$
<br />_J!i�cldont _
<br />$
<br />2,000,000
<br />0
<br />'I OTHER:
<br />AUTOMOBILELIABILITY
<br />7C'2X"rAF_7440L34A-18
<br />10/0112018
<br />10/0112019
<br />BODILY INJURY (Per person)
<br />$ N/A
<br />AUTO
<br />X OWNED SCHEDULED
<br />_ AUTOS ONLY AUTOS
<br />]X
<br />BODILY INJURY (Pident)
<br />(Per accident)
<br />$ NIA
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />$ N/A
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB x OCCUR
<br />CUD11102-10
<br />10/0112018
<br />10101/2019
<br />EACH OCCURRENCE
<br />$ 1'000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />EXCESS LIAR CLAIMS -M DE
<br />$
<br />DED F] RETENTnNJ__
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS* LIABILITY YIN
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? F_N ]
<br />(Mandatory In NH)
<br />NIA
<br />TC2J-UB-8049X508-18 (AOS)
<br />TRK-UB-8049X5iA-18 (AZ,MA,OR,WI)
<br />I OT011201 9T070
<br />1010112018
<br />-17207r—
<br />10/01/2019
<br />I PTERf
<br />_T�1_
<br />6 VTg.A---...F'_...--_-----___.
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L.DISEASE-EA EMPLOYEE
<br />$ 1,000,000
<br />I
<br />It yes, desCril)D Linder
<br />DESCRIP-1 ION OF OPERATIONS below
<br />I
<br />E,L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />. . . ........ .
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Sohodolo, may be attached If more space Is required)
<br />RE: 17-075
<br />SEE ATTACHED
<br />REVIEWED BY: EUNICE HEREDIA (PG 1OF
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA, TYRONE CHESANE,K_1_, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA 1EIREOF, NOTICE WILL BE DELIVERED IN
<br />THE EXPIRATION DATE T1
<br />SANTA ANA, CA 02702~~ ACCORDANCE WITH THE POLICY PROVISIONS,
<br />SEP 2 8 2018 AUTHORIZED REPRESENTATIVE
<br />M of Marsh USA Inc,
<br />Manashi Mukheoee _VAIO.A�"
<br />0 1988.2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD
<br />PR 17-
<br />
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