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HomeMy WebLinkAboutSIEMENS INDUSTRY, INC. (10) INSURANCE NOT ON FILE WORK MAY NOT PROCEED CITY CLERK OCT 0 4 2024 ti 1 , DATEMAYOR t CITY MANAGER Valerie Amezcua �.d7 , Alvaro Nunez MAYOR PRO TEM -�.et CITY ATTORNEY Thai Viet Phan Sonia R.Carvalho COUNCILMEMBERS CITY CLERK Phil Bacerra 4,4? Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez < David Penaloza Benjamin Vazquez CITY OF SANTA ANA A-2020-202-02 POLICE DEPARTMENT 0• FD(1) 60 Civic Center Plaza•P.O.Box 1981 Dst C-wnlwlcz-�kF) Santa Ana,California 92702 www.santa-ana.orq/PD September 9,2024 Siemens Industry,Inc. Michael Dietsch,Enterprise Account Executive 10775 Business Center Drive Cypress,CA 90630 Re: Second Extension of Master Services Agreement for the On-Going City-Wide Video Surveillance System to Provide Maintenance and Repair Services No.A-2020-202 Pursuant to Section 3.a,("Term")of Agreement No.A-2020-202,entered into by Siemens Industry Inc. and the City of Santa Ana,dated October 20,2020,as amended,the time period of said Agreement is hereby extended for a second additional one (1) year period from November 1, 2024 to October 31, 2025. The insurance certificates are required to be extended and/or renewed to cover this time extension. All other terms and conditions of said Agreement,as amended,remain unchanged and in full force and effect. Sincerely, ROBERT RODRIGUEZ Acting Chief of Police,Santa Ana Police Department CITY OF S TA ANA ATTEST Arita ALVARO NUNEZ IFER .HAL City Manager -Cl-G1t. SIEMENS INDUSTRY,INC. APPROVED AS TO FORM /041‘- Electronically signed by:4 Benjamin j • PDate:OT Sep9,Peeples024 14:21 A �n/ By: Benjamin Peeples,Branch General Manager T MARA B GOSIAN Title: Senior Assistant City Attorney Tabr`an (Mole Electronically signed by: Fabian Umole Date:Sep 22.2024 19:48 PDT Fabian Umole,Branch Financial Manager SANTA ANA CITY COUNCIL Valerie Amezcua Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Bacerra Johnathan Ryan Hernandez David Penaloza Mayor Mayor Pm Tern,Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 vamezcua@santa-ana.orq IphaniBlsanla-ana.om bvazquez(dsanla-ana.orq jessielopez(dsanla-ana.orq pbacerrabisanta-ana.prq jryanhemandez(a)santa-ana.orq dpenaloza(ohsanta-ana.orq A� 1 o/22/v2025® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 2o25 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,LLC. NAME` HONE 445 SOUTH STREET A/CC No Ext: FAX No): MORRISTOWN,NJ 07960-6454 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102147003-RAM-PROF-25/26 4433 WHITE NOC60 INSURERA: Zurich American Insurance Company 16535 INSURED INSURER B: Travelers Property Casualty Co.of America 25674 SIEMENS INDUSTRY,INC. 1000 DEERFIELD PARKWAY INSURER C: American Guarantee&Liability Insurance Company 26247 BUFFALO GROVE,IL 60089-4513 INSURER D: Travelers Casualty&Surety Company 19038 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-010974624-13 REVISION NUMBER: 12 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY GL00444023-00 10/01/2025 10/01/2026 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X� OCCUR DAPREMISESMAGE TOEa RENTEo D ccurrence $ 1,000,000 MED EXP(Any one person) $ 100,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 10,000,000 X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ INCL OTHER: $ B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-TIL-25 10/01/2025 10/01/2026 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ N/A X OWNED SCHEDULED BODILY INJURY(Per accident) $ N/A AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ N/A C X UMBRELLA LAB X OCCUR AUC0444024-00 10/01/2025 10/01/2026 EACH OCCURRENCE $ 1,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION UB-8P83929A-25-51-K(AOS) 10/01/2025 10/01/2026 X PER oTH- AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $STATUTE ER D ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N N/A UB-8P79233A-25-51-R(AZ,MA,WI) 10/01/2025 10/01/2026 1,000,000 OFFICER/MEMBER EXCLUDED? 51 B (Mandatory in NH) TWXJ-UB-7440L338-TIL-25(OH) 10/01/2025 10/01/2026 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under """"""'$500K LIMIT/$500K SIR"""""" DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A PROFESSIONAL LIABILITY EOC3245701-00 10/01/2025 10/01/2026 Limit 2,000,000 SIR 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE:ALL OPERATIONS SEE ATTACHED APPROVED By Tu Tran Nguyen at 3:34 pm, Oct 22,2025 Tu Tran Digitally signed by Tu Tran Nguyen CERTIFICATE HOLDER CANCELLATION Nguyen 15:35:18-oroo CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:RISK MANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA,4TH FLOOR ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA,CA 92701 AUTHORIZED REPRESENTATIVE of Marsh USA LLC ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102147003 LOC#: Morristown ACOOR" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,LLC. SIEMENS INDUSTRY,INC. 1000 DEERFIELD PARKWAY POLICY NUMBER BUFFALO GROVE,IL 60089-4513 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance RE:ALL OPERATIONS THE CITY OF SANTA ANA,IT'S OFFICERS,OFFICIALS,EMPLOYEES,AND VOLUNTEERS 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 WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECTS TO GENERAL LIABILITY. COMPLETED OPERATIONS COVERAGE IS INCLUDED IN 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 TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT,WHICHEVER IS LESS. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NAME: SIEMENS CORPORATION COMMERCIAL AUTO POLICY EFFECTIVE: 10-01-25 TO 10-01-26 POLICY NUMBER: TC2J—CAP-7440L34A—TIL-25 ISSUE DATE: 09-08-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION II —COVERED AUTOS signed by you before the "bodily injury" or "property LIABILITY COVERAGE in the BUSINESS AUTO damage" occurs and that is in effect during the policy COVERAGE FORM and Paragraph e. in A.1., Who Is period, to name as an additional insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE in the MOTOR CARRIER which this insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form is that person's or organizations liability for the conduct part of your policy: of another"insured". This includes any person or organization who you are required under a written contract or agreement CA T4 37 02 16 O 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. POLICY NAME: SIEMENS CORPORATION COMMERCIAL AUTO POLICY EFFECTIVE: 10-01-25 TO 10-01-26 POLICY NUMBER: TC2J—CAP-7440L34A—TIL-25 ISSUE DATE: 09-08-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION II — LIABILITY signed by you before the "bodily injury" or "property COVERAGE in the BUSINESS AUTO COVERAGE damage" occurs and that is in effect during the policy FORM and Paragraph e. in A.1., Who Is An Insured, period, to name as an additional insured for Liability of SECTION II — LIABILITY COVERAGE in the Coverage, but only for damages to which this MOTOR CARRIER COVERAGE FORM, whichever insurance applies and only to the extent of that Coverage Form is part of your policy: person's or organizations liability for the conduct of This includes any person or organization who you are another"insured". required under a written contract or agreement CA T4 37 08 17 Q 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission POLICY NAME: SIEMENS CORPORATION POLICY EFFECTIVE: 1.0-01--25 TO 10-01-26 POLICY NUMBER: TC2J--CAP-7440L34A--TIL-25 ISSUE DATE: 09-08-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 60 WHEN WE DO NOT RENEW(Nonrenewal): Number of Days Notice: 60 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION■ AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS B. If we do not renew this policy for any legally A. If we cancel this policy far any legally permitted permitted reason other than nonpayment of reason other than nonpayment of premium, and a premium, and a number of days is shown for number of days is shown for Cancellation in the When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of Schedule above, we will mail notice of cancellation to the person or organization shown nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the in such Schedule. We will mail such notice to the address shown in the Schedule above at least the address shown in the Schedule above at least the number of days shown for Cancellation in such number of days shown for When We Do Not Schedule before the effective date of cancellation. Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T4 00 05 19 0 2019 The Travelers Indeinnkr Company.All rights reserved. Page 1 of 1 POLICY NAME: SIEMENS CORPORATION POLICY EFFECTIVE: 10-01-25 TO I0-01-26 COMMERCIAL AUTO POLICY NUMBER: TC2J-CAP-7440L34A-TIL-25 ISSUE DATE: 09-08-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A.5., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any "accident" or"loss", provided that the CONDITIONS Section: "accident" or "loss" arises out of the operations 5. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver ap- ers To Us plies only to the person or organization desig- We waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 02 15 02015 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 0 Additional Insured — Automatic — Owners, Lessees Or Z U RI C H Contractors Policy No. Eff. Date of Pol. Exp. Date of PoL Eff.Date of End. Producer No. Add'I. Prem Return Prem. G L00444023-00 10/01/202 5 10/01/2026 10/01/2025 10099-000 I N C L THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: SIEMENS CORPORATION Address [including ZIP Code]: 200 WOOD AVENUE SOUTH ISELIN, NJ 08830 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or"personal and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreementto provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the"occurrence"which caused the "bodily injury" U-GL-1175-F CW(04113) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. or"property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence"or offense that may result in a claim; 2. We receive written notice of a claim or"suit"as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV—Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b.You are required by written contractor written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b.of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III— Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U-GL-1175-F CW(04113) Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its,permission. Blanket Notification to Others of Cancellation Z U R I C H or Non-Renewal THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLOO444023-00 Effective Date: 10/1/2025 This endorsement applies to insurance provided under the: Commercial General Liability Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. Such list: 1. Must be provided to us prior to cancellation or non-renewal; 2. Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed;and 3. Must be in an electronic format that is acceptable to us. B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice c f cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list: 1. Within 10 days of the effective date of the notice of cancellation, if we cancel for non-payment of premium;or 2. At least 30 days prior to the effective date of: a. Cancellation,if cancelled for any reason other than nonpayment of premium; or b. Non-renewal, but not including conditional notice of renewal, unless a greater number of days is shown in the Schedule of this endorsement for the mailing or delivering of such notification with respect to Paragraph B.1.or Paragraph 13.2.above. C. Our mailing or delivery of notification described in Paragraphs A.and B.of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not: 1. Extend the Coverage Part cancellation or non-renewal date; 2. Negate the cancellation or non-renewal;or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. U-GL-1521-13 cw tav1sy Page 1 of 2 Includes copyrighted material of Insurance Services Offlos,Inc.,with Its permission. 0 Waiver Of Subrogation (Blanket) Endorsement Z U R I C H Policy No. Eff Date of Pal. I ap. Date of PoL I Eff.Date of End. Producer AM'L Preen Return Pf m. GLOO444023-00 10/01/2025 1 10/01/2026 1 10/01/2025 10099-000 INCL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement,which is executed before a loss,to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest ❑-GL-925 B CW(12/01) Page 1 al NAMED INSURED: SIEMENS CORPORATION POLICY EFFECTIVE: I0-0I-25 TRAVELER� WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)- POLICY NUMBER: UB-8P83929A-25-5I-x WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 09-08-25 ST ASSIGN: