Insurance Requirements

Certificate of Insurance Requirements

March 10, 2020

INSTRUCTIONS FOR COUNTY OF ERIE, ERIE COMMUNITY COLLEGE STANDARD INSURANCE CERTIFICATE I.

Insurance shall be procured and certificates delivered before commencement of work or delivery of merchandise or equipment.

II.

CERTIFICATES OF INSURANCE A. Shall be made to the "County of Erie and Erie Community College, 4041 Southwestern Blvd. Orchard Park, NY 14127" B. Coverage must comply with all specifications of the contract. C. Must be executed by an insurance company, agency or broker, which is licensed by the NYS Department of Financial Services. If executed by a broker, notarized copy of authorization to bind or certify coverage must be attached.

III.

Forward the completed certificate to: Erie Community College, (Department or Division) responsible for entering into the agreement for construction, purchase, lease or service.

IV. Minimum coverage with limits are as follows:

Vendor Classification

Commercial Gen. Liab.

A Construction and Maintenance

B Purchase or Lease of Merchandise or Equipment

C Professional Services

D Property Leased To Others Or Use Of Facilities Or Grounds

E Concessionaires Services

F Livery Services

$1,000,000 per occ.

G H All Purposes Athletic Fields and Public Gyms Entity Contracts

I Use of Pools

$1,000,000 CSL

$1,000,000

$1,000,000 CSL

$1,000,000

$1,000,000 CSL

$1,000,000

General Aggregate Products Completed Operations Liability

$2,000,000

Blanket Broad Form Contractual Liability

INCLUDE INCLUDE

INCLUDE

Contractual Liability Broad Form P.D. X.C.U. (explosion, collapse, Underground)

INCLUDE INCLUDE

Athletic Participant Liability

INCLUDE INCLUDE INCLUDE (where INCLUDE (where applicable *) applicable *)

INCLUDE (where applicable *)

Abuse and Molestation Auto Liab.

$1,000,000 CSL

Owned

INCLUDE

Hired

INCLUDE

Non-Owned

INCLUDE

Excess/Umbrella Liab. Worker's Compensation

$1,000,000 CSL $1,000,000 CSL $1,000,000 CSL

$5,000,000

$1,000,000

$5,000,000

$1,000,000

$2,000,000

STATUTORY

$1,000,000

N/A

$5,000,000 3,000,000

N/A

$1,000,000

N/A

Gen. Liab., Auto Liab., & Excess

Broad Form Vendors May Be Required

Gen. Liab., Auto Liab., & Excess

& Employer's Liability Disability Benefits Professional Liability Cyber Liability Erie County, Erie Community College To Be Named Add'l Insd.

V.

Construction contracts require excess Umbrella Liability limits of $5,000,000.

VI

Coverage must be provided on a primary-non contributory bases.

Gen. Liab., Gen. Liab., Auto Auto Gen. Liab., Auto Liab., & Excess Liab., & Excess Liab., & Excess

VII. Designated Construction Project General Aggregate Limit Per Project Endorsement CG 25 03 is required. VIlI. In the event the concessionaire is required to have a N.Y.S. license to dispense alcoholic beverages an endorsement for liquor liability is required IX.

Waiver of Subrogation: Required on all lines unless noted

X.

Abuse and Molestation included for activities involving children - $1,000,000 Limit (ie. Daysports, Camps, etc.)

XI.

Transportation of people in buses, vans or station wagons requires $5,000,000 excess liability.

XII. Workers Compensation: State Workers' Compensation / Disability Benefits Law Use Applicable Certificates Below:

CE-200 C105.2 SI-12 GSI-105.2 U-26.3

Exemption Commercial Insurer Self Insurer Group Self Insured New York State Insurance Fund

CE-200 DB-120.1 DB-155

Exemption Insurers Self Insured

XIII Cyber Liability coverage must be provided in instances where vendors/contractors have access to the County's IT network and/or any personal and confidential information

XIV Pollution/Environmental Liability coverage required for projects involving the remediation, handling, transporting and/or disposal of hazardous waste Including but not limited to asbestos, lead and any other substance determined to be a Pollutant or Contaminant by the (DEC)

XV

The "ACORD" form certificate may be used in place of the County of Erie Standard Insurance Certificate, provided that all of the above referenced requirements are incorporated into the "ACORD" form certificate.

XVI Endorsement CG2038 (Additional Insured) or equivalent should be used in construction contracts where there is no direct contract between the Contractor performing services and ECC/Erie County

Page 1

SAMPLE DATE (MM/DD/YYYY)

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(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). CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS:

PRODUCER

FAX (A/C, No):

INSURER(S) AFFORDING COVERAGE

NAIC #

INSURER A : INSURED

INSURER B : INSURER C : INSURER D : INSURER E : INSURER F :

COVERAGES

CERTIFICATE NUMBER:

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

ADDL SUBR INSD WVD

TYPE OF INSURANCE

POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY)

POLICY NUMBER

COMMERCIAL GENERAL LIABILITY

X CLAIMS-MADE X OCCUR x Includes XCU X Blanket Contractual

X X

GEN'L AGGREGATE LIMIT APPLIES PER: PROPOLICY LOC JECT

X

LIMITS

EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)

$

MED EXP (Any one person)

$

PERSONAL & ADV INJURY

$

GENERAL AGGREGATE

$

PRODUCTS - COMP/OP AGG

$

COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person)

AUTOMOBILE LIABILITY

ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

$

OTHER:

X

$

SCHEDULED AUTOS NON-OWNED AUTOS ONLY

X

$

1,000,000

$

BODILY INJURY (Per accident) $

X

PROPERTY DAMAGE (Per accident)

$ $

x

UMBRELLA LIAB EXCESS LIAB

x

OCCUR CLAIMS-MADE

X X

EACH OCCURRENCE

$

AGGREGATE

$

10,000

DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

$

Y/N N/A

SUBMIT proof of Workers Compensation and disability as per examples attached

PER STATUTE

5,000,000

OTHER

E.L. EACH ACCIDENT

$

E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT

$

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

SA

County of Erie and Erie Community College are included as an additional insured. Coverage applies on a primary and non-contributory basis for work performed on the following policy numbers:

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

E PL

County of Erie and Erie Community College 4041 Southwestern Blvd. Orchard Park, NY 14127

ACORD 25 (2016/03)

CANCELLATION

M

CERTIFICATE HOLDER

AUTHORIZED REPRESENTATIVE

Understanding New York Workers Compensation Board Workers Compensation and N.Y.S Disability Benefits Liability This is a brief description for governmental organizations to validate vendor workers compensation and NYS Disability Benefits coverage. These requirements should be used when applying for permits, licenses or secure contracts. Copies should be obtained not only at the initial issuance but at renewal as well. A full instruction manual can be obtained from the Workers Comp Board. The forms discussed are: 1) Form CE-200- Affidavit of Exemption (obtain at: https://www.wcb.ny.gov/icexempt/index.jsp)  Acceptable proof that the business listed is exempt from providing workers’ compensation and/or disability insurance coverage. 2) Workers Compensation 

Form C-105.2: Certificate of Workers Compensation (WC) (Obtain from your insurance agent)  All private NYS licensed workers’ compensation carriers are required to issue the C-105.2.



Form SI- 12: Certificate of WC when self-insured. (Obtain from workers compensation board)  Only the Self-Insurance Office of the Workers’ Compensation Board issues the SI-12. The Self-Insurance Office can be contacted at 518-402-0247. Only one legal name and Federal Employer Identification Number can be listed on each Form SI-12. (Multiple legal entities must not be listed.)



Form GSI- 105.2: Certificate of WC when participating in a group self-insured program.  The self-insurance administrator of the group completes the form.



Form U-26.3: Certificate of WC  Acceptable proof that the business has workers’ compensation coverage through the New York State Insurance Fund. Only available through (NYSIF).

3) New York State Disability Benefits Law (DBL) 

Form DB-120.1: Certificate of DBL Insurance (obtain from workers compensation board)  The DB-120.1 must be completed by either the NYS statutory disability benefits insurance carrier, or a licensed NYS insurance agent of that carrier. The form can be obtained by contacting the Bureau of Compliance. (certificates@wcb.ny.gov)



Form DB-155: Certificate of DBL Self-Insurance  The Self-Insurance Office of the Workers’ Compensation Board issues the DB-155. The Board’s secretary will approve the DB-155. The Self-Insurance Office can be contacted at 518-402-0247.

4) Exemption 1, 2, 3, or 4 Family, Owner Occupied residence (http://www.wcb.ny.gov/content/main/forms/bp-1.pdf) NOTE: ACORD Certificates of Insurance are not acceptable proof. Must use one of the forms noted above: Page 3

STATE OF NEW YORK WORKERS’ COMPENSATION BOARD

CERTIFICATE OF NYS WORKERS’ COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address only)

1b. Business Telephone Number of Insured

1c. NYS Unemployment Insurance Employer Registration Number of Insured

Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy)

1d. Federal Employer Identification Number of Insured or Social Security Number

2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder)

3a. Name of Insurance Carrier

E

3b. Policy Number of entity listed in box “1a”

3c. Policy effective period

PL

____________________ to ____________________

3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included)

M

all excluded or certain partners/officers excluded.

SA

This certifies that the insurance carrier indicated above in box “3" insures the business referenced above in box “1a” for workers’ compensation under the New York State Workers’ Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box “2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box “3c", whichever is earlier. Please Note: Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by:

________________________________________________________________________ (Print name of authorized representative or licensed agent of insurance carrier)

Approved by:

________________________________________________________________________ (Signature)

Title:

(Date)

________________________________________________________________________

Telephone Number of authorized representative or licensed agent of insurance carrier: _______________________ Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07)

www.wcb.state.ny.us Page 4

Workers’ Compensation Law

Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed.

SA

M

PL

E

2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter.

C-105.2 (9-07) Reverse Page 4

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MEMORANDUM OF INSURANCE

DATE 10-Mar-2020

This Memorandum is issued as a matter of information only to authorized viewers for their internal use only and confers no rights upon any viewer of this Memorandum. This Memorandum does not amend, extend or alter the coverage described below. This Memorandum may only be copied, printed and distributed within an authorized viewer and may only be used and viewed by an authorized viewer for its internal use. Any other use, duplication or distribution of this Memorandum without the consent of Marsh is prohibited. "Authorized viewer" shall mean an entity or person which is authorized by the insured named herein to access this Memorandum via https://marshdigital.marsh.com/marshconnect/viewMOI.action?clientId=894. The information contained herein is as of the date referred to above. Marsh shall be under no obligation to update such information. COMPANIES AFFORDING COVERAGE

PRODUCER

Marsh USA Inc. ("Marsh")

Co. A National Co. B The

INSURED

Ecolab Inc., Nalco Company LLC, Nalco Champion 1 Ecolab Place St. Paul Minnesota 55102 United States

Union Fire Ins Co of Pittsburgh PA

Insurance Company of the State of Pennsylvania

Co. C New

Hampshire Ins. Co.

Co. D ACE

Property & Casualty Ins Co

Co. E American

Home Assurance Company

Co. F

COVERAGES 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 MEMORANDUM 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

CO LTR

TYPE OF INSURANCE

POLICY NUMBER

A GENERAL LIABILITY GL5425808 A Commercial GL5425813 (Products) General Liability Occurrence

POLICY POLICY EFFECTIVE EXPIRATION DATE DATE

31Dec2019 31Dec2019

31-Dec2020 31-Dec2020

LIMITS

LIMITS IN USD UNLESS OTHERWISE INDICATED GENERAL AGGREGATE

USD 5,000,000

PRODUCTS COMP/OP AGG

USD 15,000,000

PERSONAL AND ADV INJURY

USD 2,000,000

EACH OCCURRENCE

USD 2,000,000 Prem / USD 5,000,000 Products

FIRE DAMAGE (ANY ONE FIRE)

USD 500,000

MED EXP (ANY ONE PERSON)

A AUTOMOBILE LIABILITY A Any Auto A

D

EXCESS LIABILITY

Umbrella Form

CA9767380 (AOS) CA9767381 (MA) CA9767382 (VA)

XEUG27930426005

GARAGE LIABILITY

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31Dec2019 31Dec2019 31Dec2019

31-Dec2020 31-Dec2020 31-Dec2020

31Dec2019

31-Dec2020

COMBINED SINGLE LIMIT

USD 5,000,000

BODILY INJURY (PER PERSON) BODILY INJURY (PER ACCIDENT) PROPERTY DAMAGE

EACH OCCURENCE

USD 10,000,000

AGGREGATE

USD 10,000,000

AUTO ONLY (PER

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https://marshdigital.marsh.com/marshconnect/viewMOI.action ACCIDENT) OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE

C WORKERS COMPENSATION / EMPLOYERS C LIABILITY C THE B PROPRIETOR / PARTNERS / EXECUTIVE OFFICERS ARE Included

WC046912744 (AOS) WC046912745 (AK,AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT) WC046912749 (FL) WC046912746 (WI) (incl Stop Gap ND,WA,WY)

B Workers Compensation E Workers Compensation

WC046912748 (MA) WC046912747 (CA)

A Excess Workers XWC5565581 (OH) Compensation

31Dec2019 31Dec2019 31Dec2019 31Dec2019

31-Dec2020 31-Dec2020 31-Dec2020 24-Dec2020

31-Dec2019 31-Dec2019

31-Dec2020 31-Dec2020

31-Dec- 31-Dec2019 2020

WORKERS COMP LIMITS

Statutory

EL EACH ACCIDENT

USD 2,000,000

EL DISEASE POLICY LIMIT

USD 2,000,000

EL DISEASE EACH EMPLOYEE

USD 2,000,000

See Above

WC Statutory Limits;

EL 1M/1M Excess of 1M SIR

The Memorandum of Insurance serves solely to list insurance policies, limits and dates of coverage. Any modifications hereto are not authorized.

MEMORANDUM OF INSURANCE

DATE

10-Mar-2020

This Memorandum is issued as a matter of information only to authorized viewers for their internal use only and confers no rights upon any viewer of this Memorandum. This Memorandum does not amend, extend or alter the coverage described below. This Memorandum may only be copied, printed and distributed within an authorized viewer and may only be used and viewed by an authorized viewer for its internal use. Any other use, duplication or distribution of this Memorandum without the consent of Marsh is prohibited. "Authorized viewer" shall mean an entity or person which is authorized by the insured named herein to access this Memorandum via https://marshdigital.marsh.com/marshconnect/viewMOI.action?clientId=894. The information contained herein is as of the date referred to above. Marsh shall be under no obligation to update such information. PRODUCER

INSURED

Marsh USA Inc. ("Marsh")

Ecolab Inc., Nalco Company LLC, Nalco Champion 1 Ecolab Place St. Paul Minnesota 55102 United States

ADDITIONAL INFORMATION

Any person or organization is included as additional insured on the auto liability, general liability and umbrella liability policies, where required by written contract executed prior to loss. Refer to the sections below for the applicable additional insured, waiver of subrogation, notice of cancellation and other endorsements that may apply, where required by contract. All endorsements are issued on a blanket basis without having to specifically name individual customers or others on an endorsement. **** Named Insured: coverage under the policies shown above apply to Ecolab Inc., its subsidiaries, and business units including but not limited to the following: Ecolab Inc. https://marshdigital.marsh.com/marshconnect/viewMOI.action

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1 Ecolab Place St. Paul, MN 55102 Chemstar Ecolab Production LLC Ecolab USA EcoSure Ecovation, Inc. Food Protection Services LLC Food Safety Specialists, Inc. FPS Region 3 LLC Kay Chemical Lobster Ink US, Inc. Microtek Medical, Inc. Pest Elimination Research Fumigation Co., LLC Royal Pest Solutions, Inc. Swisher

Nalco Company LLC 1601 West Diehl Road Naperville, IL 60563 Abednego Environmental Services, LLC Cascade Water ChemStaff Nalco Industrial Outsourcing Nalco Production LLC Nalco U.S. 2 Inc. Nalco Water Nalco Water Pretreatment Solutions, LLC Quantum Technical Services, LLC

Nalco Champion * 7705 Highway 90-A Sugar Land, TX 77478 Champion Technologies, Inc. ChampionX Holding Inc. ChampionX LLC. ChampionX USA Inc. * coverage remains in effect under the Ecolab coverages until these businesses are spun-off from Ecolab at which time coverage by Ecolab will cease and will be replaced by separate coverage for the ChampionX businesses.

Additional Insured: Where required by written contract executed prior to loss, the certificate holder and any person or organization are included as additional insured on the auto liability, general liability and umbrella liability policies. The following endorsements are attached to the policies shown above: General Liability (Premises/Ongoing Operations) and General Liability (Products/Completed Operations) Additional Insured-Where Required Under Contract or Agreement CG2010 (Premises); 94954 (Products) Additional Insured-Vendors CG2015 Additional Insured-Primary Insurance 74434 (Premises/Ongoing Operations); 94955 (Products/Completed Operations) General Liability (Premises/Ongoing Operations) Additional Insured-State of Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CG2012 Additional Insured-Lessor of Leased Equipment CG2028 https://marshdigital.marsh.com/marshconnect/viewMOI.action

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Additional Insured-Owners, Lessees or Contractors-Automatic Status When Requirement in Construction Agreement with You CG2033 Additional Insured-Owners, Lessees or Contractors - Scheduled Person or Organization CG2010 General Liability (Products/Completed Operations) Additional Insured-Owners, Lessees or Contractors-Completed Operations CG2037 Automobile Liability Additional Insured-Where Required Under Contract or Agreement 87950 Lessor-Additional Insured and Loss Payee CA2001 Insurance Primary as to Certain Additional Insureds 74445 Waiver of Subrogation: Where required by written contract executed prior to loss, waiver of subrogation is granted on the auto liability, general liability, workers' compensation and umbrella liability policies. The following endorsements are attached to the policies shown above: General Liability (Premises/Ongoing Operations) and General Liability (Products/Completed Operations): Waiver of Transfer of Rights of Recovery Against Others to Us CG2404 Automobile Liability: Waiver of Transfer of Rights of Recovery Against Others to Us 62897 Workers Compensation & Employers Liability: Waiver of Our Right to Recover from Others WC000313 Notice of Cancellation: The following endorsements are attached to the policies shown above: General Liability (Premises/Ongoing Operations), General Liability (Products/Completed Operations) and Automobile Liability: Limited Advice of Cancellation to Scheduled Entities 108538 Workers Compensation & Employers Liability: Limited Advice of Cancellation Provided Via Email to Entities Other Than the Named Insured WC990056 Pesticide or Herbicide Applicator Coverage CG2264 is attached to the general liability (premises) liability policy shown above Blended Pollution Named Peril & Time Element is attached to the general liability (premises) policy shown above Waiver of Governmental Immunity Endorsement CG2414 is attached to the general liability (premises) policy shown above Alternate Employer Endorsement WC000301, WC000301A are attached to the workers'compensation policies shown above. Longshore and Harbor Workers' Compensation Act Coverage Endorsement WC000106A is attached to the workers' compensation policies shown above. Maritime Coverage Endorsement WC000201B (Jones Act) is attached to the workers' compensation policies shown above. Outer Continental Shelf Lands Act Coverage Endorsement WC000109C is attached to the workers' compensation policies shown above. Umbrella SIR of USD$1M is applicable only to General or Products Liability first loss after primary limits are exhausted. Umbrella POLICY TERRITORY IS WORLDWIDE. As respects the U.S., Umbrella is excess of general liability, auto liability, and employers liability primary coverage's. As respects Canada and other countries, coverage applies excess of a retained amount USD$5M per occurrence for general liability, products liability, and USD$3 million per occurrence for employer's liability and auto liability. This retained limit can be satisfied either through insurance or paid by Ecolab. Limits shown are in US Dollars (USD) The insurance evidenced herein and in the referenced policies is not intended to provide coverage beyond that required by written contract, beyond the Named Insured' s indemnification obligations or at law. The Memorandum of Insurance serves solely to list insurance policies, limits and dates of coverage. Any modifications hereto are not authorized.

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