2015-517-E AMS - Power Quality Solutions LLC - UPS Service Agreement

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DocuSign Envelope ID: lA7ABOC1-4543-4D35-BEC3-943C36543933 A`°R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) D08112/2015 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 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' 200 PUBLIC SQUARE,SUITE 1000 ANON o Ext: A/C No): CLEVELAND,OH 44114 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 12345e-EPQC-#11 -15-16 INSURERA:Old Republic Insurance Company 24147 INSURED INSURER B: EATON US HOLDINGS,INC., EATON CORPORATION PLC,EATON CORPORATION AND ALL OTHER DIVISIONS INSURER C: SUBSIDIARIES AND CONTROLLED ASSOCIATE COMPANIES THAT ARE PART OF INSURER D: EATON OR COOPER INDUSTRIES EATON CENTER 1000 EATON BOULEVARD INSURER E: CLEVELAND,OH 44122 INSURER F: COVERAGES CERTIFICATE NUMBER: 05-004985490-01 REVISION NUMBER:I 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 POLICYNUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY N MWZY 304046 01/01/15 01/01/16 EACH OCCURRENCE $ 5,000,000 DAMAGE RENTED X COMMERCIAL GENERAL LIABILITY PR M SESOEa occurrence $ 2,500,000 CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,500,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 10,000,000 X POLICY PRO- LOC PROD COMP/OP OCC $ 6,500,000 A AUTOMOBILE LIABILITY N MWTB 302899 01101/15 01/01116 COMBINED SINGLE LIMIT 7,500,000 Ea accidert 1xX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS X NON-0WNED PROPERTY DAMAGE $ AUTOS Peracddent $ UMBRELLA LIAB HOCCUR N EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 1 $ A WORKERS COMPENSATION MWC 304045 00(A OS) 01/01115 01/01/16 X WC sTATU- oTH- AND EMPLOYERS'LIABILITY 5,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE a E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA 5,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A EXCESS WORKERS COMP MWXS 304044(OH) 01/01/15 01/01/16 EMPLOYERS LIABILITY 4,000,000 (STATUTORY) SELF INSURED RETENTION 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILLSBOROUGH,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Kevin Robinson 7>✓'w<%►t RoGcrtNrt ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) Issued By:WEB USEIfhe ACORD name and logo are registered marks of ACORD