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Honeywell - Insurance Certificate (2018)�— ® �`� ° CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 03/23/2018 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 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 AOn Risk Services Northeast, Inc. New York NY Office CONTACT NAME: (A/CC..NNo. Ext): (866) 283 -7122 (ac No.): 800- 363 -0105 E -MAIL ADDRESS: 199 Water street New York NY 10038 -3551 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Greenwich Insurance Company 22322 Honeywell International Inc. 115 Tabor Road Morris Plains NJ 07950 USA INSURERS: XL Insurance America Inc 24554 INSURER C: XL specialty Insurance Co 37885 INSURER D: INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence INSURER F: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570070515094 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADD IN SD SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY RGC 4 7 5 04/01/2018 04 1 1 EACH OCCURRENCE $5,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $5,000,000 MED EXP (Any one person) $50,000 PERSONAL& ADV INJURY $5,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $5,000, 000 X POLICY ❑ PRO JECT F-1 LOC PRODUCTS - COMP /OPAGG Included OTHER: A AUTOMOBILE LIABILITY RAC943764205 ADS 04/01/2018 04/01/2019 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTYDAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER /EXCLUDED ?EXECUTIVE (Mandatory in NH) N / A RWD943540305 ADS RWC943 540205 AK, WI 04/01/2018 04/01/2018 04/01/2019 04/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $5,000,000 E.L. DISEASE -EA EMPLOYEE $5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $5,000,000 C Excess WC RWE943540405 04/01/2018 04/01/2019 EL Each Accident $5,000,000 AZ, OH, WA EL Disease - Ea Emp $5,000,000 SIR applies per policy terns & condi ions EL Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Proj: RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419] [AI: City of Gilroy, its officers and employees] are included as additional insured for General Liability and Automobile Liability with respect to Honeywell operations in connection with Honeywell Contract # 40098419. CERTIFICATE HOLDER 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. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna St Gilroy CA 95020 USA 1XK072 i� %[� e/rit.P.S�ITr•D V l� e../!Z� ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD N } w d .c d d a 0 S V rn 0 u� LO CD 0 0 r Lo O Z d il5 U w d U .�R J Z�_ AGENCY CUSTOMER ID: 570000054391 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMEDINSURED Honeywell International Inc. POLICY NUMBER see Certificate Number: 570070515094 CARRIER see certificate Number: 570070515094 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. WSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YYYY) POLICY EXPIRATION DATE (MM/DD /YYl'Y LIMITS OTHER Excess WC Limits c are Statutory in RWE943540505 Excess WC - NM SIR applies per policy to 04/01/2018 ms & conditions 04/01/2019 AZ, OH, WA, & NM ACORD 101 (2008 /01) ©2008 ACORD CORPORATION. All rights reserv ed. The ACORD name and logo are registered marks of ACORD Excess WC Limits are Statutory in AZ, OH, WA, & NM ed. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RGC943763005 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): Location(s) Of Covered Operations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 ©Insurance Services Office, Inc. ISO I Commercial General Liability Forms 107/01/04 POLICY NUMBER: RGC943763005 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004