|
ACORi1 CERTIFICATE OF LIABILITY:INSURANCE
<br />y11/06/2014
<br />DATE(MM/DDMlYY)
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may 'require an endorsement. A statement on this certificate does•not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Marsh USA, Inc.
<br />13015th Avenue, Suite 1900
<br />Seattle, WA 98101
<br />Attn: Seattie.CertRequest@marsh.com / F: 212-948-4326
<br />184424-STND-GAWUp-14-15
<br />CONTACT
<br />PPHON:
<br />IANC No Ext): NE FAX
<br />No):
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />. NAIC #
<br />INSURER A : Continental Casualty Company
<br />20443
<br />INSURED
<br />Physio -Control International, Inc.
<br />Physio -Control, Inc.
<br />11811 Willows Road NE
<br />Redmond, WA 98052
<br />INSURER B National Fire Insurance of Hartford
<br />20478
<br />INSURER c : NIA
<br />N/A
<br />INSURER D :
<br />$ 1,000,000
<br />INSURER E :
<br />$ 1,000,000
<br />INSURER F :
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<br />SEA -002504094-01
<br />REVISION NUMBER: 2
<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 />TYPE OF INSURANCE
<br />INSRIN
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />IMM/DD/YYYY)
<br />LIMITS
<br />A
<br />GENERAL
<br />X
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />4030507381
<br />05/01/2014
<br />05/01/2015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 1,000,000
<br />CLAIMS -MADE
<br />X
<br />OCCUR
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEL
<br />X
<br />AGGREGATE LIMIT APPLIES
<br />POLICY E�
<br />PER:
<br />LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ EXCLUDED
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED
<br />AUTOS
<br />HIRED AUTOS
<br />SCHEDULED
<br />AUTOS
<br />NON -OWNED
<br />AUTOS
<br />4029265138
<br />.
<br />05/01/2014
<br />05/01/2015 •
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />COMP / COLL DED._
<br />$ 1,000
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />—
<br />OCCUR
<br />CLAIMS -MADE
<br />•EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />DED RETENTION$
<br />$
<br />A
<br />A
<br />•WORKERS COMPENSATION
<br />AND.EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Y / N
<br />N
<br />N I A
<br />4030507378 (AOS)
<br />4030507364 (CA)-
<br />05/01/2014
<br />05/01/2014
<br />05/01/2015
<br />05/01/2015
<br />• X
<br />WC STATU-
<br />TORY LIMITS
<br />OTH-
<br />FR
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarke•Schedule, 11 more space Is required)
<br />Additional Insured status applies to General Liability and Auto Uability only tf it is reflected in your written contract. Medtronic includes but is not limited to the following entities: Physio -Control, Inc., Medtronic
<br />Sofamor Danek, Inc., Medtronic Spine, LLC (Including Osteotech, Inc.), Minimed Distribution Corporation, Salient Surgical Technologies, Inc., PEAK Surgical, Inc. and Medtronic ATS Medical, Inc.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />Indian River County Fire Rescue
<br />Attn: Cory S. Richter, BA, NREMT-P
<br />Battalion Chief Training & QA
<br />4225 43rd Avenue
<br />Vero Beach, FL 32967-1671
<br />SHOULD ANY OF THE ABOVE.DESCRIBED'POL'ICIES BE CANCELLED+BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE :'WILL BE .DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Cheryl Bermudez
<br />ACORD 25 (2010/05)
<br />©'1988-2010 ACORD'CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered:marks of ACORD
<br />125
<br />
|