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HomeMy WebLinkAboutInsurance Certificate: Evoqua Water Technologies LLC a DATE (MM/DDIYYYY) AC"RO CERTIFICATE OF LIABILITY INSURANCE 01/1412016 " 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 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: FAX PHONE Six PPG Place, Suite 300 /c No Ext : ac No Pittsburgh, PA 15222 AIL -DDRESS: INSURER(S) AFFORDING COVERAGE NAIC tt --GAWUP-16-17 Bowen INSURER A : Lexington Insurance Company 19437 INSURED EWT HOLDINGS III CORP. INCLUDING INSURER B : National Union Fire Ins Co Pittsburgh PA 19445 EVOQUA WATER TECHNOLOGIES LLC INSURER C : New Hampshire Insurance Co. 23841 1451 E. NINE MILE ROAD INSURER D : N/A N/A HAZEL PARK, MI 48030 INSURER E :Berkley Assurance Company 39462 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-005003516-02 REVISION NUMBER:3 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY 014180804 101/15/2016 01/15/2017 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ~ OCCUR PDAMAGE TO REM SES (Ea olccu ence $ 1,000.000 X SIR: $750,000 MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 OTHER $ : B AUTOMOBILE LIABILITY CA3632394 (AOS) 101/15/2016 01/15/2017 Ee aBINEDISINGLE LIMIT $ 5,000,000 B v ANY Au 1-0 CA3632395 (MA) 01/15/2016 01/15/2017 BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED CA3632396 (VA) 01/15/2016 01/15/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ OWNED X HIRED AUTOS X NON-AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION WC035808874 (ADS) 01/1512016 01/15/2017 X SPER TATUTE OTH AND EMPLOYERS' LIABILITY Y SEE ATTACHED 1,000,000 E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ~ NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E1 . DISEASE - POLICY LIMIT $ E ENV. PROT. PROFESSIONAL PCAB-5000255-0116 01/15/2016 01/15/2017 LIMIT 2,000,000 & POLLUTION LIABILITY SIR 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS, AND EMPLOYEES ARE HEREBY ADDITIONAL INSURED UNDER THE REFERENCED GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICIES WHERE REQUIRED BY WRITTEN CONTRACT. SUCH INSURANCE AS IS AFFORDED BY THE ADDITIONAL INSURED ENDORSEMENT SHALL APPLY AS PRIMARY INSURANCE & OTHER INSURANCE MAINTAINED BY THE CERTIFICATE HOLDER SHALL BE EXCESS ONLY & NOT CONTRIBUTING WITH INSURANCE PROVIDED UNDER THIS POLICY. CERTIFICATE HOLDER CANCELLATION City of Ashland, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Kan Olson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeee~r~ was. .fi4 , c tc. as ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC Pittsburgh ACO ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. EWT HOLDINGS III CORP. INCLUDING EVOQUA WATER TECHNOLOGIES LLC POLICY NUMBER 1451 E. NINE MILE ROAD HAZEL PARK, MI 48030 CARRIER fJAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance FORMERLY SIEMENS WATER TECHNOLOGIES ADDITIONAL WORKERS COMPENSATION POLICIES: POLICY NUMBER: WC035808875 STATE(S) COVERED: IL, KY, INC, NH, UT, VT INSURER: NEW HAMPSHIRE INSURANCE CO. EFFECTIVE AND EXPIRATION DATES: 1115/2016 - 1/15/2017 POLICY NUMBER: WC035808876 STATE(S) COVERED: NJ, PA INSURER: NEW HAMPSHIRE INSURANCE CO. EFFECTIVE AND EXPIRATION DATES: 1,115/2016-1/15/2017 POLICY NUMBER: WC035808877 STATE(S) COVERED: AZ, VA INSURER: NEW HAMPSHIRE INSURANCE CO. EFFECTIVE AND EXPIRATION DATES: 1/15/2016-1/15/2017 POLICY NUMBER: WC035808878 STATE(S) COVERED: CA INSURER: NEW HAMPSHIRE INSURANCE CO. EFFECTIVE AND EXPIRATION DATES: 1/15/2016-1/15/2017 POLICY NUMBER: WC035808879 STATE(S) COVERED: MA, ND, OH, WA, WI INSURER: NEW HAMPSHIRE INSURANCE CO. EFFECTIVE AND EXPIRATION DATES: 1/15/2016-1/15/2017 POLICY NUMBER: WC035808880 STATE(S) COVERED: FL INSURER: ILLINOIS NATIONAL INSURANCE COMPANY EFFECTIVE AND EXPIRATION DATES: 1/15/2016 - 1/15/2017 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0001428 SP 0031 -C01-P01428-1 City of Ashland, Oregon Attn: Kari Olson 90 N. Mountain Avenue Ashland, OR 97520