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Certificates of Insurance . � CERTIFICATE OF LIABILITY fDATE�(MwODffYyrA� 1010 12020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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. It 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($). PRODUCER CONTACT MARSH USA,INC. NAME _ _ .__ .. PHONEFAik 445 SOUTH STREET W No.gat?:.___ ___ __.m_ ..._ _ (A/C.No): MORRISTOWN,NJ 0796OZ454 E4AAIL _ADDRESS, INsuRI R s AFFORDING eovERAGE CN102147003-RAM-PROF 20121 228 GRAM NOC60 INSURER,A:HDI Giobd huuranmCompany 41343 INSURED INSURER SIEMENS INDUSTRY,INC. B:Travelers Property Casua%ll o America 25674 _ _ 10D0 DEERFIELD PARKWAY INSURER C The Travelers indemnity"Company 2%58 BUFFALO GROVE,IL 60089-4513 INSURER D INSURER E INSURER.F- COVERAGES CERTIFICATE NUMBER., NYC-009184004-24 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR ...TYPEOFINSURANCE NDC.SUBEti- ------POtICYNUMBER_...-_._........_n_ P DNYY M -....._ LIMITS '.LTR IN A X COMMERCIAL GENERAL LIABILITY �GLD11101-12 10101/2020 � 10/0112021 EACH OCCURRENCE a__ � .._. ___— 1 0�,000 MAGE TO RENTED CLAIMS-MADE. _.X DA OCCUR �Yl a PREMISES(Ea occurrence,[ __$ 10,D00 MEDEXP-(Any one,persora) S 100,000 � y PERSONAL S ADV INJURY $ 1,000,000 ^•-�•-- �, � _m_ __.._____ GEN'L AGGREGATE LIMIT APPLIES PER. j GENERAL AGGREGATE $ 10 000,000 X POLICY O- LOC WAt PRODUCTS-COMPIOP AGG $ INCL - OTHER: .. ... $ B AUTOMOBILELIABILITY TC2J-CAP-7440L34A-TIL-20 1010112020 10101/2021 COMBINED SINGLE LIMIT $ 2,000,000 _-. ER accident) X ANY AUTO BODILY INJURY(Per person) t$ NIA OWNED SCHEDULED N I X BODILY INJURY(Peracadent) $ NIA AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE -- $ - ..N/A__ AUTOS ONLY AUTOS ONLYacsidentl.-__— $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS IJAB CLAIMS-MADE { AGGREGATE. DED [ RETENTION$ $ B WORKERS COMPENSATION. UB-SP$3929A-20-51-K(AOS) 1&0112020 1010112021 X PER OTH- IANDE#PLOYERS`LIABILrfY STATUTE __- ER C YIN UMP79233AFN] L 20-51- AZ,MA,OR,WI 10/0112020 10/0112021 ANYPROPMETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 1000,000 B OFFICERIMEMSEREXCLUDED? NIA _ _. ._ ....... -- (Mandatory in NH). TWXJ-UB-74401.338-20(Olt) ,I. 1010112020 1010912021 E L DISEASE-EA EMPLOYEE$ 1,000,000 9I yzs.atorydescri i e under __ __._ - ..- DESCRIPTIONOFOPERATIDNSbelow „ „ KLIrAITI$500KSIR""„'° E.L.DISEASE-POLICY LIMIT $ 1,000,000 A PROFESSIONAL LIABILITY EOD5618801 1111112021 1111112121 1,000,000 Deductible:$1,000,000 DESCRIPTION OF OPERATIONSI LOCATIONS 1 VEHICLES(ACORD 101,.Additional Remarks Schedule,maybe attached it more space is required) RE:JOB NO.NA. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSURANCE COMPLIANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1111 12TH STREET,SUITE 408 ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST,FL 33040 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee @ 1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNN O2'147003 LOC : Morristown ADDITIONAL REMARKS SCHEDULEPage 2 of 2 AGENCY NAMED INSURED MARSH USA,INC. SIEMENS INDUSTRY,INC. 1000 DEERFIELD PARKWAY POLICY NUMBER BUFFALO GROVE,IL 6W8OA513 CARRIER NAIC COl7E EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of t iabili Insurance RE:JOB NO.NA. MONROE COUNTY BOCC IS HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT UNDER THE REFERENCEO GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES. WAIVER OF SUBROGATION IS EFFECTUAL WHERE REQUIRED BY WRITTEN CONTRACT. 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 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER TC2J—CAP-744OL34A—TIL-20 COMMERCIAL AUTO 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 2015 The Travelers Indemnity Company.All rights reserved. Page I of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. POLICY NUMBER: GLDI 1101-12 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person OrOrganization: ANY PERSON OR ORGANIZATION TO THE EXTENT REQUIRED BY WRITTEN CONTRACT -information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CC 24 04 05 09 Oc Insurance Services Office, Inc.,2008 Page 1 of 1 • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY) 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: PHONE FAX 445 SOUTH STREET IA/c,No,Est): (A/C,No): MORRISTOWN,NJ 07960-6454 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 100129-SBT--19/20 228 KOZHE NOC60 INSURER A:HDI.Global Insurance Company 41343 INSURED INSURER B:Travelers Property Casualty Co.of America 25674 SIEMENS INDUSTRY,INC. 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-009194619-17 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 D/ LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DYYYY) A X COMMERCIAL GENERAL LIABILITY GLD1110111 10/01/2019 10/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO TED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 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 JECOT PR LOC PRODUCTS-COMP/OP AGG $ INCL OTHER: $ B AUTOMOBILE LIABILITY TC2J-CAP-7440L34A-19 10/01/2019 10101/2020 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) _X ANY AUTO _ BODILY INJURY(Per person) $ N/A X OWNED SCHEDULED ,, AGEMENT BODILY INJURY(Per accident) $ N/A AUTOS ONLY AUTOS p;, X HIRED X NON-OWNED APPR� ,,litM PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY C3Y r�����)1 (Per accident) NIA WA1E FR NI 1 $ WAIN • %+a UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION TC2J-UB-8049X508-19(AOS) 10/01/2019 10101/2020 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N TRK-UB-8049X51A-19(AZ,MA,OR,WI) 10/01/2019 10/01/2020 E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? N N/A TWXJ-UB-7440L338-19(OH&WA) 10/01/2019 10/01/2020 (Mandatory inin NNH) 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 $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS INCLUDED AS ADDITIONAL INSURED UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES,BUT ONLY WITH RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED,SIEMENS INDUSTRY,INC.FOR CERTIFICATE HOLDER UNDER CONTRACT. 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 TC 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT,WHICHEVER IS LESS. CERTIFICATE HOLDER CANCELLATION MONROE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BOARD OF COUNTY COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 SIMONTON STREET,ROOM 268 ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST,FL 33040 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee o�en�ese �iQw�tGr� t r ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 76 ACOREP CERTIFICATE OF LIABILITY INSURANCE `.►�" DATE (MMDD/YYYY) 09112/2017 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 MARSH USA, INC. 445 SOUTH STREET CONTACT NAME: PHCN o FVC No): E-MAIL ADDRESS: MORRISTOWN, NJ 07960-6454 INSURERS AFFORDING COVERAGE NAIC # INSURER A: HDI Global Insurance Company 41343 100129-SBT--17118 228 KOZHE NOC60 INSURED SIEMENS INDUSTRY, INC. BUILDING TECHNOLOGIES INSURER B : The Travelers Indemnity Company 25658 INSURER C : Travelers Property Casualty Co. of America 25674 INSURER D : The Charter Oak Fire Insurance Company 25615 1000 DEERFIELD PARKWAY BUFFALO GROVE, IL 60089 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-009194619-11 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 LTR TYPE OF INSURANCE ADDLSUBR POLICYNUMBER MMDPOLI CY EFF DIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLD1110109 10/01/2017 10101/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE M OCCUR DAMAGE PREM SESOEa occur ence $ 1,000,000 MED EXP (Any one person) $ 100,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ INCL $ rJECT OTHER: C AUTOMOBILE LIABILITY TC2JCAP7440L34A17 10/01/2017 10/0112018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ N/A ANY AUTO rXxx OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ N/A PROPERTY DAMAGE Per accident N/A HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ D B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A TC20UB8049X50817(AOS) TRKUB8049X51A17 (AZ, MA, OR 8 WI) TWXJU67440L33817 OH & WA ( ) 10101/2017 1010112017 10/01/2018 10/01/2018 1010112018 X IPERSTATUTE IERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below """'$500K LIMIT / $500K SIR' E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS INCLUDED AS ADDITIONAL INSURED UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES, BUT ONLY WITH RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOT E OF CEL TO THE CERTIFICATE HOLDER UP TC 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. APP V ISK LENIENT �L DATE 0 rt `in CERTIFICATE HOLDER CANCELLATION MONROE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BOARD OF COUNTY COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 SIMONTON STREET, ROOM 268 ACCORDANCE WITH THE POLICY PROVISIONS. KEY WEST, FL 33040 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. C-C, Manashi Mukherjee �+tA.,ao ter.: iQ+c-te�wc,�e�e ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD