2021-027-E AMS-Siemens Industries Seymour ionization

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DocuSign Envelope ID: B87D26F4-8DFD-42F4-9EA6-lD3CBD6749F3 ACORO0 DATE(MM/DD/YYYY) CC> CERTIFICATE OF LIABILITY INSURANCE 09/15/2020 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: NE 445 SOUTH STREET AIC,No.Ext: ac No): MORRISTOWN,NJ 07960-6454 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# CN102147003-RAM--20/21 228 Rentas NOC60 INSURER A:HDI Global Insurance Company 41343 INSURED SIEMENS INDUSTRY,INC. INSURER B:Travelers Property Casualty Co.of America 25674 1000 DEERFIELD PARKWAY INSURER C:The Travelers Indemnity Company 25658 BUFFALO GROVE,IL 60089-4513 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009196547-22 REVISION NUMBER: 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 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY GLD11101-12 10/01/2020 10/01/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE To RE TED CLAIMS-MADE �OCCUR PREM SES I a oN_."snce $ 1,000,000 MED EXP(Any one person) $ 100,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ INCL JECT OTHER: $ B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-TIL-20 10/01/2020 10/01/2021 COMBINED SINGLE LIMIT g 2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ NIA X OWNED SCHEDULED BODILY INJURY(Per accident) $ N/A AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ NIA AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION UB-8P83929A-20-51-K(ADS) TOM020 10/01/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C Y/N UB-8P79233A 20 51-R(AZ,NIA,OR,WI) 10/01/2020 10/01/2021 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENi $ B OFFICER/MEMBER EXCLUDED? N N/A 7440L338 UB- - 10/01/2020 10101/2021 (Mandatory in NH) TWXJ20OH( ) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under """""$500K LIMIT/$500K SIR I'll 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:JOB NO.N/A SEE ATTACHED J CERTIFICATE HOLDER CANCELLATION COUNTY OF ORANGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ASSET MANAGEMENT SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 600 NC HIGHWAY 86 A ACCORDANCE WITH THE POLICY PROVISIONS. HILLSBOROUGH,NC 27278 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeef ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD