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COI - TK Elevator Corporation - Expires 2022-10-01
CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 DATE (MM/DD/YYYY) 08/11/2022 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 Central,Inc. 200 East Randolph CHICAGO,IL 60601 INSURED TK Elevator Corporation f/k/a ThyssenKrupp Elevator Corporation CONTACT NAME:Aon Risk Services Central,Inc. PHONE (A/C No.Ext):(866)283-7122 FAX (A/C No.Ext):(800)363-0105 E-MAIL ADDRESS:acs.chicago@aon.com INSURER(S)AFFORDING COVERAGE NAIC # INSURER A:HDI Global Insurance Company 41343 INSURER B:ACE American Insurance Company 22667 INSURER C:Indemnity Insurance Company of NA 43575 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2185853 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PROJECT LOC OTHER: X GLD5668801 /GLD5668901 10/01/2021 10/01/2022 EACH OCCURRENCE $5,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence)$100,000 MED EXP (Any one person)$5,000 PERSONAL &ADV INJURY $5,000,000 GENERAL AGGREGATE $10,000,000 PRODUCTS -COMP/OP AGG $10,000,000 B AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY ISA H25555594 10/01/2021 10/01/2022 COMBINED SINGLE LIMIT (Ea accident)$4,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ CUD5669101 10/01/2021 10/01/2022 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 C B C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N If yes,describe under DESCRIPTION OF OPERATIONS below N/A WLR C67816912 (AOS) WLR C6781695A (CA,MA) WLR C67816997 (TK Airport) 10/01/2021 10/01/2021 10/01/2021 10/01/2022 10/01/2022 10/01/2022 X PER STATUTE OTHER E.L.EACH ACCIDENT $1,000,000 E.L.DISEASE -EA EMPLOYEE $1,000,000 E.L.DISEASE -POLICY LIMIT $1,000,000 Limits shown as requested: DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Division Number:100000 -Named Insured Includes:TK Elevator Corporation -Address:3100 Interstate N Circle SE Suite 500 ATLANTA,GA 30339 Project Number:-Project Name:City of Gilroy -Address:7400 Monterey St GILROY,CA 95020 -Project Type (s):Elevator Maintenance CERTIFICATE HOLDER CANCELLATION City of Gilroy,its officers,officials and employees 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. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 3C23122B-3960-4663-9713-1E9B03E379DE AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY POLICY NUMBER See First Page CARRIER See First Page NAIC CODE NAMED INSURED TK Elevator Corporation f/k/a ThyssenKrupp Elevator Corporation EFFECTIVE DATE: ADDITIONAL REMARKS CERTIFICATE NUMBER: 2185853 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Gilroy,its officers,officials and employees The Additional Insured(s)listed above is/are added as Additional Insured(s)with respect to Automobile,General Liability and Umbrella 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 DocuSign Envelope ID: 3C23122B-3960-4663-9713-1E9B03E379DE Page 3 of 3 DocuSign Envelope ID: 3C23122B-3960-4663-9713-1E9B03E379DE