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ThyssenKrupp Elevator - Insurance Certificate® CERTIFICATE OF LIABILITY INSURANCE Page 1 of DATE(M 09/299/2015 12015 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 terns 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 Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 CHICAGO, IL 60606 CONTACT NAME:Wilft of Illinois Inc. ADDL INSR PHONE A/C No.Ezt : 312 - 288 -7489 FAX A/C No.Et : 312 - 621 -6866 E-MAIL ADDRESS*tke.certificatesoMilis.com :POLICY EXP (MWDD/YYYY) INSURER(S) AFFORDING COVERAGE A NAIC # INSURER A: HDI-Gerling America Insurance Company 41343 INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER B: ACE American. Insurance Company EACH OCCURRENCE 22667 INSURER C: Indemnity Insurance-Company of NA $ 1,000;000 43575 INSURER Di Agri General Insurance Company PERSONAL & ADV INJURY 42757 INSURER E: ACE Fire Underwriters Insurance Company $2,000,000 20702. INSURER F: COVERAGES CERTIFICATE NUMBER: 943298 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) :POLICY EXP (MWDD/YYYY) LIMITS _ A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F PROJECT F_� LOC 61-D1257442 10/01/2015 10/01/2016 EACH OCCURRENCE $_2,000;600 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000;000 MED EXP (Anyone person) $.5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS- COMP /OP AGG $2,000;000 B AUTOMOBILE LIABILITY �( ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS ISAH08859279 10/01/2015 10/0112016. COMBINED SINGLE LIMIT (Ea accident) $ 2,000;000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) MBRELLA LIAB EXCESS LIAB DED RETENTION OCCUR CLAIMS -MADE $ HOCCURR_ ENCE REGATE B C D E ORKERS COMPENSATION YIN' ND EMPLOYERS' LIABILITY Y PROPRIETOR/PARTNER/EXECUTIVE FFICER/MEMBER'EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRC48590007 (ADS) WLRC48589996 (CA,MA) WLRC48593306 (TN) SCFC48590019 (WI) 10/0112015 10/01/2015 10/01/2015 10/01/2015 10/01/2016 10/01/2016 10/0112016 10/01 /2016 WC STATU- OTHER TORY LIMITS JE EACH ACCIDENT $ 1,000,000 DISEASE -EA EM PLOYEE $'1 000 000 DISEASE - POLICY LIMIT- S-11,000,000 DESCRIPTION OF OPERAATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number: 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300'KENNESAW 30144 Project Number: 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 United States SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH, THE POLICY PROVISIONS. �C 4GURD 25 (ZU1WU5) Tne AGURD name and logo are registered marks of ACORD AC40 AGENCY POLICY NUMBER See First Page CARRIER See First Page ADDITIONAL REMARKS AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 NAIC CODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM nTLE: CERTIFICATE OF LIABILITY INSURANCE CITY OF GILROY, IT S OFFICERS AND EMPLOYEES NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 DATE: The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 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). Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 CHICAGO, IL 60606 INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 I PHONE (A/C No.Ext) 312- 288 -7489 1 FAX (A/C No.Ext): 312 - 621 -6866 1 INSURER(S) AFFORDING COVERAGE I NAIC 9 I INSURER A: HDI- Gerllno America Insurance CDmDanV 141343 INSURER C: I INSURER E: ACE INSURER F: COVERAGES CERTIFICATE NUMBER: 943405 REVISION NUMBER: 22667 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (M MID DNYYY) POLICY EXP MWDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR GEN'L AGGR_EGATE'LIMIT APPLIES PER: X POLICY F—] PROJECT F__J LOC GLD12574 02 10!0112015 10/01/2016 EACH OCCURRENCE $_2 0.00,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000;000 PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY )( ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 0 ISAH08859279 10/01/2015 10/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DIED RETENTION OCCUR CLAIMS -MADE $ EACH OCCURRENCE GGRRGATE B IWORKERS C D E COMPENSATION Y/N E&N D EMPLOYERS' LIABILITY PROPRIETOR/PARTNE R/EXECUTNE CERIMEMBER EXCLUDED? s, de c be s, describe under CRIPTION OF OPERATIONS, below NSA WLRC48590007 (AOS) WLRC48589996 (CA,MA) WLRC48593306 (TN) SCFC48590019 (WI) 10/01/2015 10/01/2015 10/01/2015 10/01/2015 10/01/2016 10/01/2016 10/01/2016 10/01/2016 X WC STATU- OTHER TORY LIMITS E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1;000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS ! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number. 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number: 044 -28800 - Project Name: GILROY POLICE DEPARTMENT, 7301 HANNA ST, GILROY GEKTIFIGATE HOLDER CITY OF GILROY 7351 ROSANNAST GILROY, CA 95020 United States CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD TENTATIVE ©1988 -2010 A00 il%.� AGENCY AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 POUCY NUMBER See First Page CARRIER NAIC CODE See First Page ADDITIONAL REMARKS NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C� CERTIFICATE OF LIABILITY INSURANCE Page l of DATE 101141 ODIYYYY) 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 NAME:WiII)s of Illinois Inc. Willis of Illinois, Inc. PHONE A/C No.Ext : 312- 288 -7489 FAX A/C No.Ext 312- 621 -6866 233 S. Wacker Drive, Suite 2000 E -MAIL ADDRESS:tka.certlficates wlllis.com CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC # ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 770131 REVISION NUMBER: 41343 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 ADDL INSR SUBR WVD, POLICY NUMBER POLICY EFF (MMIDDNYYY) 'POLICY EXP (MM/DD/YYYY) LIMITS A ENERAL.LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR United States""�'�..- GLD12574-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 50ob GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PROJECT Fj LOC PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $1000,000 [3 AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED E] SCHEDULED AUTOS AUTOS HIRED AUTOS [:] NON -OWNED AUTOS ISAH08828052 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Penperson) BODILY INJURY (Per accident) (Per DAMAGE (Per accident) UMBRELLA LIAB XCESS LIAB DIED RETENTION OCCUR CLAIMS -MADE $ ACH OCCURRENCE GGREGATE B C WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTfVE N FFICER/MEMBER EXCLUDED? � Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRC48017630 (AOS) WLRC48017629 (CA,MA) 10/01/2014 10/01/2014 10/01/2015 10101/2015 X WC STATU- OTHER TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Division Number: 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town. Park Drive, Suite 300 KENNESAW.30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET �AsS GILROY, CA 95020 S. United States""�'�..- ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of3 AGENCY NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE j EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD W-101 ADDITIONAL INSURED Blanket Automatic- Where Required By'Contract Named insured.:.. Thyssen.Klrupp Elevator:C&pqration Policy Number. GLD125 1 74-0 . I Policy'Peridd-- 10ffil12014to:1010162015 Section 1.1 —Who -IsAn Insured — is amended by adding the following paragraph: 4. , Any'persbnj firm, co=ration'orqoVemmentbo for whom1heyou are obil atedbvrVjrtueotg, OY g. wir . itten contract oragmeim 6nt entered: into with respect to your manufacture; sale, distribution, 411 Service, repair 6rins ection.of elevators'an6elated devic6s,,parts- an d 'Oomponents,. to afford coverage such as provided by this policy. The c 'r'' ''' ed fdiian� such additi6riil'imure , ise sl Ii " 6d ' ' ' ove age provid d xPres y irr"t to apoly.6111y,10 arising; ut of. operations conducted by or., bryou under the written contract or agreement and 9 en n ' 161he e)d6rit"requiried by sur wriften agreement. Nd:cove-'rag'e is:provt e r any th 6 ly additional, insured4br the liability which: arises in any manner,; ,dirdctly or indirect! i other than 'frolm: conducted' operations o .. . - I , I lc;ted y r •for you- 1. " . .All ,'6ther'tarrhs. giid'ddiiditibiis I remain .unchanged. / DATE (MM/DD/YYYYJ 'kCORO CERTIFICATE OF LIABILITY INSURANCE Page 1of1 09/27/2014 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 CONTACTNAME:Willis of Illinois Inc. Willis of Illinois, Inc. PHONE A/C No.Ext 312- 288 -7489 FAX A/C No.Ezt : 312 -621 -6866 233 S. Wacker Drive, Suite 2000 E -MAIL ADDRESS:tka.certificates@willis.com CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HDI- Gerlino America Insurance COmDanV 141343 INSURED ThyssenKrupp Elevator Corporation 2140 Zenker Road San Jose CA 95131 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 725289 REVISION NUMBER: 43575 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 MAYBE 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP (MM/DONM LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY a PROJECT FI LOC GLD12574 -01 10101/2014 10/01/2015 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 B AUTOMOBILE LIABILITY 5X ANY AUTO ALL OWNED 0 SCHEDULED AUTOS AUTOS HIRED_ AUTOS NON -OWNED AUTOS ISAH08828052 10/0112014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person)_ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DIED RETENTION OCCUR CLAIMS -MADE $ EACH OCCURRENCE kGGREGATE B C ORKERS COMPENSATION Y/N ND EMPLOYERS' LIABILITY Y PROPRIETOR/PARTNER/EXECUTNE FFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRC48017630 (AOS) WLRC48017629 (CA,MA) 10/01/2014 10/01/2014 10/01/2015 10/01/2015 X WC STATU- OTHER TORY Umrrs LJ E.L. EACH ACCIDENT $1,000,000 .L. DISEASE -EA EMPLOYEE. $ 1,000,000 L. DISEASE- POLICY'LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number•. 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number: 044 -28800 - Project Name: GILROY POLICE DEPARTMENT, 7301 HANNA ST, GILROY CERTIFICATE HOLDER CITY OF GILROY 7351 ROSANNA S T GILROY, CA 95020 United States WORD 25 (2010/05) .ATION ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANCE WITH THE POLICY PROVISIONS. Ijl ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD /yC®0 Page 1 of 2 DA 09 M/2�1�) � CERTIFICATE OF LIABILITY INSURANCE 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(iss) 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 NAME-Willis of Illinois Inc Willis of Illinois, Inc. PHONE A /C_No.Ext . '312- 288 -7489 FAX A/C_No.Ext : 312 - 621 -6866 233 S. Wacker Drive, Suite 2000 E-MAIL ADDRESS.*tke.certificatestgrMUis.com CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC # INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 717025 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP (MMMDN YYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X i GLD12574-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2;000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Anyone person) $ 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F1 PROJECT F_ ,LOC PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED D SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS ❑ ISAH08828052 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DED RETENTION OCCUR CLAIMS -MADE $ CH OCCURRENCE GGREGATE _ B C WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVE FFICER/MEMBER EXCLUDED? Mandatory In NH) f yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRC48017630 (ADS) WLRC48017629 (CA,MA) 10101/2014 10/01/2014 10/01/2015 10/01/2015 X WC STATU- OTHER LJ TORY LIMITS L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $' 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1. 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number: 0001 -Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 United States ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD a AC40 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zarlker Road San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 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 PRODUCER Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 CHICAGO, IL 60606 INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: INSURER(S) AFFORDING COVERAGE I NAIC # COVERAGES CERTIFICATE NUMBER: 717025 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MWOONYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PdPOLICY PROJECT F_� LOC United States GLD12574-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1;000,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED F-1 SCHEDULED AUTOS AUTOS HIRED AUTOS F-1 NON-OWNED AUTOS ❑ ISAH08828052 10/01/2014 10101/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAR EXCESS LIAR DED M RETENTION F1 OCCUR CLAIMS -MADE $ CH OCCURRENCE GGREGATE B C' WORKERS COMPENSATION YIN AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? Mandatory InNHI f yes, describe under 9ESCRIPTION OF OPERATIONS below N/A WLRC48017630 (AOS) WLRC48017629(CA,MA) 10/01/2014 10101/2014 10/01/2015 10/01/2015 X WC STATU- OTHER TORY LIMITS .L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1 000 D00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number: 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 United States ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMEDINSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road' San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE j EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM, IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC® ® CERTIFICATE OF LIABILITY INSURANCE Page DATE(MM/ l7 09/27/22014 014 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 NAME:Wlllis of Illinois Inc. Willis of Illinois, Inc PHONE A/C No.Ext `. 312- 288 -7489 FAX A/C No.Ext : 312 -621 -6866 233 S. Wacker Drive, Suite 2000 E -MAIL ADDRESS:tka.rertifir-atesL%vAllis.com CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HDI-Gerling America Insurance Company 41343 INSURED INSURER e: ACE American Insurance Company 22667 ThyssenKrupp Elevator Corporation INSURER c: Indemnity Insurance Company of NA 43575 2140 Zanker Road INSURER D: San Jose CA 95131 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 717025 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM/DDNYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X United States GLD12574-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F-1 PROJECT F—] LOC PERSONAL & ADV INJURY $ 2,000,0_00 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP _AGG $ 2,000,000 _ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS F-1 ISAH08828052 10/01/2014 10/01 /2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person) BODILY'INJURY (Per accident) (Per DAMAGE (Per accident) UMBRELLA LIAB XCES_ S LU\B DIED RETENTION OCCUR CLAIMS -MADE $ CH OCCURRENCE GGREGATE B C' IIf WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE N OFFICER/MEMBER EXCLUDED? Mandatory in NH) yes, describe under DESCRIPTION OF OPERATIONS below NSA WLRC48017630 (AOS) WLRC48017629 (CA,MA) 10/01/2014 10/01/2014 10/01/2015 10/01/2015 X WC STATU- OTHER TORY UMITS .L. EACHACCIDENT $ 1' 000 000 L. DISEASE -EA EMPLOYEE _ $ 1 000,000_ .L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number. 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CEF2111-1GA 1 t HL]LLItK CANCtLL.A I IUN ®1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 Y United States ®1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE j EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional. Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008/01) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A00RO ® Page 1 of 2 DATE (MM /DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0912712014 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 Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 CHICAGO, IL 60606 INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER(S) AFFORDING COVERAGE I NAIC # I I INSURER A: HDI- Gerlino America Insurance ComDanV 141343 D: INSURER F: COVERAGES CERTIFICATE NUMBER: 717025 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD LIMBS A GENERAL LIABILITY )( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PROJECT F7 LOC United States GLD12574-01 10/01/2014 10101/2015 EACH OCCURRENCE_ $ 2,000,000 DAMAGE TORENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000 ;000 GENERAL AGGREGATE $ 2,000;000 PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS E7 ISAH08828052 10/01/2014 10/01/2015 COMBINED SINGLEI.IMIT (Ea accident) $ 2,000;000. BODILY INJURY(Per person) BODILY `INJURY (Per accident) PROPERTY,DAMAGE (Per accident) MBRELLA LIAB CESS LWB DED F7RETENTION OCCUR CLAIMS -MADE $ CH OCCURRENCE GGREGATE 6 C WORKERS COMPENSATION �,M AN EMPLOYERS' LIABILITY ANY PR OPRIETOR/PARTNER/EXECUTIVE N FFICER/MEMBER EXCLUDED? L andatory in NH) yes, describe under ESCRIPTION OF OPERATIONS below NIA WLRC4801,7630 (AOS) WLRC48017629 (CA,MA) 10/0112014 10/01/2014 10/01/2015 10/01/2015 X WC STATU- OTHER TORY LIMITS LJ .L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE - - $-1,000,000 .L. DISEASE - POLICY LIMIT $ 1 000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Division Number: 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation -Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET ` GILROY, CA 95020 United States r- ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACOPRO AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008/01) ©1988 -2010 ACORD CORPORATION: All rights reserved. The ACORD name and logo are registered marks of ACORD C� ® CERTIFICATE OF LIABILITY INSURANCE Page' °f2 DA 09//2712014 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 NAME:Willis of Illinois Inc. Willis Of Illinois, Inc. PHONE A/C No.Ext : 3127288 -7489 FAX A/C No.Ext : 312 - 621 -6866 233 S. Wacker Drive, Suite 2000 E -MAIL ADDRESS:tke.certificatespMllis.com CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC # INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 INSURER A: INSURER 8: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 717025 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD 'POLICY EXP MM/DO LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR United nited States GLD12574-01 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,00.0;000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000;000 MED EXP (Any one person) $ 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F_� PROJECT F1 LOC PERSONAL & ADV INJURY $ 2,000;000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,0001000 B UTOMOBILELIABILITY X ANY AUTO ALL OWNED F] SCHEDULED AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS ❑ ISAH08828052 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB DED RETENTION OCCUR CLAIMS -MADE $ CURRENCE ATE FGGREG B G RKERS COMPENSATION YM ND EMPLOYERS' LIABILITY NY PROPRIETOR/PARTNER/EXECUTNE N FFICER/MEMBER EXCLUDED? Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA WLRC48017630 AOS) ( WLRC48017629 (CA,MA) 10/01/2014 10/01/2014 10/01/2015 10/01/2015 CSTATU- RY LIMITS OTHER H ACCIDENT $ 1,000 000 ASE -EA EMPLOYEE $ 1 000 000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Division Number. 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144 Project Number. 044 -XXXX - Project Name: GILROY POLICE DEPT 7301 HANNA ST & CITY HALL ANNEX 7370 ROSANNA ST CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 CITY OF GILROY 7351 ROSANNA STREET �' G CA 95020 I United nited States ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2of2 AGENCY NAMED INSURED ThyssenKrupp Elevator Corporation 2140 Zanker Road San Jose CA 95131 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE j EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CITY OF GILROY, IT S OFFICERS AND EMPLOYEES The Additional Insured(s) listed above is /are added as Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. ACORD 101 (2008101) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I CERTIFICATE OF LIABILITY INSURANCE ATE (MP D09/13/2013 NDDfYYYY) 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 Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 Chicago IL 60606 coNracr Helen Chen PHONE 312 - 288 -7489 FAX 312- 621 -6865 E -MAIL tke.certificates @willis.com LIMITS INSURER(S) AFFORDING COVERAGE NAIC # INSURED THYSSENKRUPP ELEVATOR CORPORATION 2140 ZANKER ROAD SAN JOSE CA 95131 - Ph:408- 392 -0910 INSURER A: HDI- Gerling America Insurance Company 41343 INSURERS: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance Company of NA 43575 INSURER D: - @1,000,000 W INSURER E: $55,000 INSURER F: $2,000,000 COVERAGES CERTIFICATE NUMBER: BHOR- 9BJ932- 130913211758 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 ITA TYPE OF INSURANCE ADDL INSR SUBR WV POLICY NUMBER POLICY EFF POLICY EFF LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GLD12574 -00 GLD12571 -00 10/01/2013 10/01/2014 EACH OCCURRENCE $2,000,000 DAMAGETO RENTED @1,000,000 W MED EXP (Any one person) $55,000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOc JF T PRODUCTS - COMP /OP AGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ISAH08722705 10/01/2013 10/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION $ - -- B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPFI]ETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A LRC47324877 (AOS) LRC4732483A CA, MA ( ) SCFC47324919 (WI) 10/01/2013 10/01/2014 X WC STATU- OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: ELEVATOR MAINTENANCE JOB# 044 -28800 GILROY POLICE DEPARTMENT, 7301 HANNA ST, GILROY CERTIFICATE HOLDER CANCELLATION CITY OF GILROY ATTN: RICK BRANDIN[ 7351 ROSANNA ST GILROY CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE �T - ACORD 25 (2010/05) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC-y, a'y ArT —.yn. �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 09114/2013 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 Willis of Illinois, Inc. 233 S. Wacker Drive, Suite 2000 Chicago IL 60606 CONTACT Helen Chen PHONE 312 - 288 -7489 Fax 312- 621 -6865 E -MAIL tke.certificates @willis.com LIMITS INSURER(S) AFFORDING COVERAGE NAIC # INSURED THYSSENKRUPP ELEVATOR CORPORATION 2140 ZANKER ROAD SAN JOSE CA 95131 ' INSURER A: HDI- Gerling America Insurance Company 41343' INSURER B: ACE American Insurance Company 22667 INSURER C: Indemnity Insurance Company of NA 43575 INSURER D: $1,000,000 INSURER E: $5,000 INSURER F: $2,000,000 COVERAGES CERTIFICATE NUMBER: BHOR- 9BJLGN- 130914071021 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 ITR TYPE OF INSURANCE ADDL INSR SUER WVO POLICY NUMBER POLICY EFF POLICY EFF LIMITS A GENERAL LIABILITY �( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GLD12574 -00 GLD12571 -00 , 10/01/2013 10/01/2014 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED $1,000,000 MED EXP (Any :ccurrencel person) $5,000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: x POLICY 7 PRO- 7 LOC PRODUCTS - COMP /OP AGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ISAH08722705 10/01/2013 10/01/2014 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION $ B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICERIMEMBER (Mandatory NH) EXCLUDED? El If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRC47324877 (AOS) LRC4732483A CA MA ( ) SCFC47324919 (WI) 10/01/2013 10/01/2014 X I WCSTATU- OTH- TORY I IMITq =a E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: ELEVATOR MAINTENANCE JOB# 044 -XXXX OLD CITY HALL, 7400 MONTEREY ROAD, GILROY, CA CERTIFICATE HOLDER CANCELLATION CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 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 ACORD 25 (2010/05) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INFORMATION 09/Date 14/2013 CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 07:10:21 AM PRODUCER Company Willis of Illinois, Inc. E 233 S. Wacker Drive, Suite 2000 Company Chicago IL 60606 F INSURED Company THYSSENKRUPP ELEVATOR CORPORATION G 2140 ZANKER ROAD Company SAN JOSE CA 95131 H TEXT The Additional Insured(s) listed below are added as an Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. CITY OF GILROY, IT S OFFICERS AND EMPLOYEES CERTIFICATE HOLDER Serial #: sHOR- 9sJLGN- 130914071021 CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 Expiring: 10/01/2014 Cert ID: BHOR- 9BJLGN- 130914071021 Policy No.: GLD12574 -00 & GLD12571 -00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED ENDORSEMENT BLANKET AUTOMATIC (WHEN REQUIRED BY WRITTEN CONTRACT) NAMED INSURED: ThyssenKrupp Elevator Corporation and all Subsidiaries ADDITIONAL INSURED(s): CITY OF GILROY, IT S OFFICERS AND EMPLOYEES JOB: RE: ELEVATOR MAINTENANCE JOB# 044 -XXXX OLD CITY HALL, 7400 MONTEREY ROAD, GILROY, CA EFFECTIVE DATE: 10/01/2013 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Additional Insured Endorsement , Blanket Automatic (When Required By Contract) It is hereby understood and agreed that Section II - Who Is An Insured - is amended by adding the following Part 5: 5. Any person, firm, corporation or government body for whom the named insured is obligated by virtue of a written contract or agreement entered into with respect to the named ins_ u red's manufacture, sale, distribution, installation, service, repair or inspection of elevators and related devices, parts and components, to afford coverage such as is provided by this policy. The coverage provided for any such additional insured is expressly limited to apply only to liability arising out of operations conducted by or for the named insured under the written contract or agreement and then only to the extent required by such written agreement. No coverage is provided for any additional insured for the liability which arises in any manner, directly or indirectly, other than from operations conducted by or for the named insured. tke.certificates@willis.com Page 1 of 4 A SR - CERTIFICATE OF LIABILITY INSURANCE _, DATE 02/01/22013 HIS 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 BLOW. 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 he policv, 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 WILLIS OF ILLINOIS INC 233 S WACKER DRIVE SUITE 2000 CHICAGO IL 60606 CONTACT Helen Chen NAME: PHONE: 312 -288 -7489 FAX: 312 621 -6865 E -MAIL: tke.certificates willis.com PRODUCER CUSTOMER #: INSURERS AFFORDING COVERAGE NAIC # INSURED THYSSENKRUPP ELEVATOR CORPORATION 2140 ZANKER ROAD SAN JOSE CA 95131 INSURER A: Lexington Insurance Company 19437 INSURER B: Wausau Bus Ins Co/Wausau Underwriters Ins Co 26069/26042 INSURER C: Indemnity Ins Cc of NA/ACE American Ins Co 43575/22667 INSURER D: INSURER E: Gene INSURER F: COVERAGES CERTIFICATE NUMBER: CKDO- 94HJ8P- 130201054953 REVISION NUMBER: HIS 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 ADD'L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM /DD/YYYY MM /DD/YYYY Gene Liability Each Occurrence $2,000,000 Damage to Rented Premises Ea occurrence $1,000,00 X Commercial General Liability A Claims Made X ccur 037205277 037205276 10/01/2012 10/01/2013 Mad Exp (Any one erson $5,00 Personal & Adv. In'ury $2,000,000 General Aggregate $2,000,000 Gen'I Aggre ate Limit Applies Per: Prod ucts -Com /O s Agg Included f%_0 113ol I Pro' I Loc utomobile X Liability ny Auto Combined Single Limit Ea accident $2,000,00 II Owned Autos Bodily Injury Per person) Bodily Injury (Per accident B Scheduled Autos ASKZ91438879012 (AOS) 10/01/2012 10/01/2013 Hired Autos ASJZ91438879032 (PR) Property Damage (per accident Non -Owned Autos Umbrella Liab ccur Each Occurrence Excess Liab is - ade T7M Aggregate Deductible Retention $ Worker's Compensation Y/N and Employers' Liability WC Statutory T imits Other C Any Proprietor / Partner / Executive Officer / Member Excluded? Mandatory in NH) If yes, describe under DESCRIPTION N/A WLRC47125042 (AOS) WLRC47125030 (CA, MA) 10/01/2012 10/01/2013 EL Each Accident $1,000,000 EL Disease - Ea Employee $1,000,00 OF OPERATIONS below EL Disease - Policy Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: ELEVATOR MAINTENANCE JOB# 044 -XXXX OLD CITY HALL, 7400 MONTEREY ROAD, GILROY, CA CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 muuru ca tcu i vwuo) ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DRDANCE WITH THE POLICY PROVISIONS. Representative �w t 1988 -2010 ACORD CORPORATION. All rights reserv; i ne AGVt(v name ana logo are registered mars of ACUKU http: / /login.crostrack. com/ cros/ certs/ tke/ tkectr- w.nsFCert+IDICKDO- 94HJ8P- 130201054953 2/1/2013 tke.certificates @willis.com Page 2 of 4 ADDITIONAL INFORMATION Date 02/01/2013 PRODUCER Company E WILLIS OF ILLINOIS INC Company 233 S WACKER DRIVE SUITE 2000 CHICAGO IL 60606 F Company G INSURED THYSSENKRUPP ELEVATOR CORPORATION Company 2140 ZANKER ROAD H SAN JOSE CA 95131 11TEXT The Additional Insured(s) listed below are added as an Additional Insured(s) with respect to Automobile and General Liability policies, but only to the extent required by written contract and only to the extent that coverage is afforded under these policies. CITY OF GILROY, IT S OFFICERS AND EMPLOYEES CERTIFICATE HOLDER Serial #: CKDO- 94HJ8P- 130201054953 CITY OF GILROY 7351 ROSANNA STREET GILROY CA 95020 http: // login. crostrack. com /cros /certs /tke /tkectr- w.nsf /Cert+ID /CKDO- 94HJ8P- 130201054953 2/1/2013 tke.certificates@willis.com Expiring: 10/01/2013 Cert ID: CKDO- 94HJ8P- 130201054953 Policy No.: 037205277 & 037205276 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED ENDORSEMENT BLANKET AUTOMATIC (WHEN REQUIRED BY WRITTEN CONTRACT) NAMED INSURED: ThyssenKrupp Elevator Corporation and all Subsidiaries ADDITIONAL INSURED(s): CITY OF GILROY, IT S OFFICERS AND EMPLOYEES JOB: RE: ELEVATOR MAINTENANCE JOB# 044 -XXXX OLD CITY HALL, 7400 MONTEREY ROAD, GILROY, CA EFFECTIVE DATE: 10/01/2012 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Additional Insured Endorsement Blanket Automatic (When Required By Contract) It is hereby understood and agreed that Section II - Who Is An Insured - is amended by adding the following Part 5: 5. Any person, firm, corporation or government body for whom the named insured is obligated by virtue of a written contract or agreement entered into with respect to the named insured's manufacture, sale, distribution, installation, service, repair or inspection of elevators and related devices, parts and components, to afford coverage such as is provided by this policy. The coverage provided for any such additional insured is expressly limited to apply only to liability arising out of operations conducted by or for the named insured under the written contract or agreement and then only to the extent required by such written agreement. No coverage is provided for any additional insured for the liability which arises in any manner, directly or indirectly, other than from operations conducted by or for the named insured. Page 3 of 4 http: / /login.crostrack. com/ cros/ certs/ tke/ tkectr- w.nsVCert+ID /CKDO- 94HJ8P- 130201054953 2/1/2013