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HomeMy WebLinkAboutXylem Water Solutions USA, Inc.AC"R"°'�CERTIFICATE OF LIABILITY INSURANCE ATE D10/30/2023D/YYYY) 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, LLC. 1166 Avenue of the Americas New York, NY 10036 CONTACT Lauren Gian rande NAME: 9 MExt : (212) 345-6000 FAX No): E-MAIL Lauren.Giangrande@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # 10/31/2023 INSURER A: AIU Insurance Co. 19399 CN1 08453421 -STND-GAW-23-24 INSURED Xylem Water Solutions USA, Inc. INSURER B: National Union Fire Ins. Co. 19445 INSURER C: Flygt Products 790-A Chadbourne Road Fairfield, CA 94534-9643 INSURER D: INSURER E SIR: $1,000,000 $ INSURER F: AUTOMOBILE X COVERAGES CERTIFICATE NUMBER: NYC -009603521-26 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,CONTRAOT 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MWDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR GL 9941282 10/31/2023 10/31/2024 EACH OCCURRENCE $ 1,000,000 DAMAGES(TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X NLOC POLICY 1 PEC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 SIR: $1,000,000 $ B A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 7620278 (AOS) 7620279 (MA) 10/31/2023 10/31/2023 10/31/2024 10/31/2024 COMBINED SINGLE LIMIT $ 3,000,000 Ea accident BODILY INJURY (Per person) $ N BODILY INJURY Per accident $ ( ) PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ 1 DED F I RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 049154515 (AOS) 049154514 (WI) 049154513 (CA) 10 31 2023 10/31/2023 10/31/2023 10/31/2024 10/31/2024 10/31/2024 X PEROTH- 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. %.r -n t trr%,M i c r1VL.L/Cr1 GANGtLLA I IUN 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 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD