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O �®
<br />ACC�
<br />�V/CERTIFICATE OF LIABILITY INSURANCE
<br />DATE /YYYY)
<br />04/30/2019/2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Marsh USA Inc.
<br />333 South 7th Street, Suite 1400
<br />CONTACT US Centralized Services
<br />NAME:
<br />PHOE
<br />A/CNNo Ext : 866-966-4664 FAX
<br />No : 212-948-5382
<br />E-MAIL
<br />ADDRESS: Minneapolis.CertRequest@marsh.com
<br />Minneapolis, MN 55402-2400
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />X
<br />INSURERA: National Union Fire Ins Cc Pittsburgh PA
<br />19445
<br />NALCO
<br />INSURED Ecolab Inc.
<br />INSURER B: ACE Property and Casualty Insurance Company
<br />20699
<br />INSURER C : New Hampshire Insurance Company
<br />23841
<br />Nalco Company LLC
<br />INSURER D: The Insurance Company of the State of PA
<br />19429
<br />Nalco Champion
<br />1 Ecolab Place
<br />INSURER E: American Home Assurance Company
<br />19380
<br />St. Paul, MN 55102
<br />INSURER F:
<br />MED EXP (Any one person)
<br />$ 0
<br />COVERAGES CERTIFICATE NUMBER: CHI -008986022-07 REVISION NUMBER: 4
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />ICY EFF
<br />DD/
<br />POLICY EXP
<br />MM/DD/
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />GL5425808
<br />12/31/2019EACH
<br />OCCURRENCE
<br />$ 2,000,000
<br />ACLAIMS-MADE
<br />X❑ OCCUR
<br />GL5425813 (Products)
<br />±12/31/2018
<br />/2018
<br />12/31/2019
<br />PREM SES Ea occurrAMAGE TO ence)
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ 0
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER :
<br />APPROVED
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />X
<br />POLICY ❑PRO ❑ LOC
<br />''.
<br />PRODUCTS - COMP/OP AGG
<br />$ 15,000,000
<br />OTHER
<br />I
<br />EACH OCC -PRODUCTS
<br />$ 5,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />CA9767380(AOS)
<br />12/31/2018
<br />12/31/2019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />A
<br />X
<br />ANY AUTO
<br />CA9767381 (MA)
<br />12/31/2018
<br />12/31/2019
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />OWNED SCHEDULED
<br />AUTOSONLY AUTOS
<br />CA9767382 (VA)
<br />12/31/2018
<br />12/31/2019
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOSONLY AUTOSONLY
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />X
<br />X
<br />XOOG27930426004
<br />12/31/2018
<br />12/31/2019
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION$25,000
<br />$
<br />C
<br />E
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N/A
<br />X
<br />WC046912744 (AOS)
<br />WC046912747 (CA)
<br />WC046912749 FL
<br />( )
<br />12/31/2018
<br />12/31/2018
<br />12/31/2018
<br />12/31/2019
<br />12/31/2019
<br />12/31/2019
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 2,000,000
<br />D
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />WC046912748 (MA)
<br />12/31/2018
<br />12/31/2019
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 2,000,000
<br />D
<br />Workers Compensation Cont.
<br />WC046912746 (WI)
<br />12/31/2018
<br />12/31/2019
<br />SEE ABOVE
<br />(incl Stop Gap ND,WA,WY)
<br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The Certificate Holder and any other persons or organizations are included as additional insured on the auto liability, general / product liability and umbrella liability policies, where required by written contract
<br />executed prior to loss. Refer to the attached page "Additional Remarks Schedule" for the applicable additional insured, insurance as primary, waiver of subrogation, notice of cancellation and other endorsements that
<br />may apply, where required by written contract. All endorsements are issued on a blanket basis without having to specifically name individual customers or others on an endorsement.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF RIVERSIDE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />RISK MANAGEMENT
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />3900 MAIN STREET
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />RIVERSIDE, CA 92522
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjeeicx�t�;
<br />@ 1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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