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Home My WebLink AboutCertificate of Insurance (2)Q 1>� CERTIFICATE OF LIABILITY INSURANCE FDATE /YYYY) 10/27/2021/2021 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 PHONE (212) 345-6000 FAX A/C. o A/C No : E-MAIL ADDRESS: Lauren.Giangrande@marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: AN 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 N/A Flygt Products 790-A Chadbourne Road Fairfield, CA 94534-9643 -INSURERD: INSURER E: GENERAL AGGREGATE $ INSURER F SIR: $1,000,000 $ COVERAGES CERTIFICATE NUMBER: NYC -009603521-19 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. /NSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GL 6547204 10/31/2021 10/31/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE 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:2,000,000 X POLICY ❑PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ 2,000,000 SIR: $1,000,000 $ B B B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED AUTOS ONLY AUTOS ONLY F CA 7031023 (AOS) CA 7031025 (VA) CA 7031024 (MA) 10/31/2021 10/31/2021 10/31/2021 10/31/2022 10/31/2022 10/31/2022 Ee aocideDISINGLE LIMIT $ 3,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ -- PROPERTY DAMAGE Per accident $ $ UMBRELLA LIABOCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ A A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) yes, describe under D DESCRIPTION OF OPERATIONS below N/A WC 65885842 (AOS) WC 65885841 (NY) WC 65885843 (WI) WC 65885840 (CA) 1013112021 10/31/2021 10131/2021 10/312022 10/3112022 10/31/2022 10/31/2022 XPER -TH- STATUTE ER E. L. 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 If 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. Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' &411za 2L'. r `7czzc. V 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Dear Certificate Holder: As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To strei rnline deliveryand in an effortto support our firm's commitment to sustainability, going forward, we would like to distribute your Certificates of Insurance electronically if passible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Please send your response to: g, erations.ernail rnarsh,cc�:m and provide the following information so that we can expedite your COI delivery. a Certificate# (Shown below Insured Name —e, .. A - 26456 9 -tai) 0 :-Mail for future defivery- For undeliverable email addresses our system is configured to automatically redirect the Certificate for del'Iveryvia USPS, Lastly, if you no longer need this Ctrl please respond to tlS eraatiorts.ernail ` rn.arsh,com with the Certificate number and we will inactive the record in our system to avoid future automatic delivery, Thank you. US Operations, Harsh USA, Inc. 0471.01-00-0001981-0002-0004795 9