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HomeMy WebLinkAboutCertificate of InsuranceA' `6RaPCERTIFICATE OF LIABILITY INSURANCE �,,,..-• FDATE /YYYY) 11/0212021/2021 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(les) 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. 1166 Avenue of the Americas New York, NY 10036 CONTACT Lauren Giangrande NAME:PHONE 212 345 6000 FAX /c ( ) A/c No): E-MAIL ADDRESS: Lauren.Gian9 rantle marsh.com INSURERS AFFORDING COVERAGE NAIC # 10/31/2021 INSURER A: AIU Insurance Co. 19399 CN108453421-STND-GAW-21-22 INSURED Xylem Water Solutions USA, Inc. INSURER B : National Union Fire Ins. Co. 19445 INSURER C : NIA NIA Fiygt Products 790-A Chadbourne Road Fairfield, CA 94534-9643 INSURER D: SIR: $1,000,000 $ B B B INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC -009603521-20 REVISION NUMBER- 0 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. 1�T TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD/YYYY POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR GL 6547204 10/31/2021 10/3112022 EACH OCCURRENCE $ 1,000,000 DAMAGES(TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X PRO POLICY 1:1LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 SIR: $1,000,000 $ B B B AUTOMOBILE X LIABILITY ANY AUTO AUTOS OWNEDONLY SCHEDULED AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CA 7031023 (AOS) CA 7031025 (VA) CA 7031024 (MA) 10131/2021 10/31/2021 10/31/2021 10/31/2022 10131/2022 10131/2022 Ea aBINEDtSINGLE LIMIT $ 3,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLALIAB EXCESS LIAR HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/M EMBER EXCLUDED?WC (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC 65885842 (AOS) WC 65885841 () NY 65885843 WI ( ) WC 65885840 (CA) 1013112021 1013112021 10/3112021 10131/2022X 10131/2022 10131/2022 1013112022 PER OTH- ER E.L.TATUTE EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) The Town of Los Altos Hills, its elective and appointed officers, employees and volunteers are included as additional insured (except workers' compensation) where required by written contract. CERTIFICATE HOLDER CANCFI_I_ATION Town of Los Altos Hills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 26379 Fremont Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Los Altos Hills, CA 94022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �.�rry� �i�4c9J"�,�', ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD