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Memorandum of Insurance (MOD
Memorandum of Insurance
DATE
MEMORANDUM OF INSURANCE
28 -Dec2015
Th is Memorandum is issued as a matter of information only to authori ze d viewers for their internal use only
and confers no rights upon any viewer of this Memorandum. Th is 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 vie wer for its internal use. Any other
use, dupl ication or distribution of th is Memorandum w ithout the consent of Marsh is prohibited . "Authorized
viewer" shall mean an entity or person wh ich is authorized by the insured named herein to access this
Memorandum via https://on line.marsh.com/marshconnectpublic/marsh2/public/moi?client=null. 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.
co.
A New
Hampshire Insurance Company
("Marsh")
co. eNational Union Fire Insurance Co of Pittsburgh, PA
INSURED
Schneider Electric Holdings, Inc. (See below for Additional
Named Insureds)
co. c HD I-Gerling
America Insurance Co,
200 North Martingale Road
Suite 1000 , Schaumburg
Illinois
Co. D
601 73
tonnif, . fJfJntr ~.c.rllne.idtr-,,Jedn~
United States
I
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 PO LICIES DESCRIBED HEREIN IS
SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY
HAVE BEEN REDUCED BY PAID CLAIMS
co
TYPE OF
LTR
INSURANCE
POLICY
POLICY
EFFECTIVE
EXPIRATION
LIMITS
POLICY NUMBER
LIMITS IN USO UNLESS OTHERWISE INDICATED
DATE
B
GENERAL
2039174
01-JAN-2016
DATE
01-JAN-2017
GENERAL AGGREGATE
$5 ,000,000
LIABILITY
PRODUCTS - COMP/OP AGO
$5 ,000,000
Commercia l
PERSON AL AND ADV
$5 ,000,000
General
INJURY
Liability
EACH OCCU RRENCE
$5,000,000
Occurrence
F1RE DAMAGE (ANY ONE
$5,000,000
FIRE)
$5,000
MED EXP (ANY ONE
PERSON)
A
AUTOMOBILE
9734254 (MA)
01-JAN-2016
01 -JAN -2017
COMBINED SINGL E LIMIT
A
LIABILITY
9734255 (VA)
01-JAN-2016
Ol-JAN-2017
DODIL Y INJURY (PER
B
Any Auto
9734256
01-JAN-2016
01 -JAN-2017
PE RSON)
(AOS)
$5 ,000,000
BODILY INJURY (PER
ACCIDENT)
PROPER TY DAMAGE
c
EXCESS LlABlLITY
Umbrella Form
CUD11986-04
01-JAN-2016
01 -JAN -2017
EACH OCCURENCE
$5 ,000,000
AGGREGATE
$5,000,000
GARAGE
AU TO ONL y (PER ACCIDENT)
LIABILITY
OTIIER THAN AUTO ONLY:
EACH ACCIDENT
I
I
I
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Memorandum of Insurance (MOI)
AGGREG ATE
A
WORKERS
068022493
01-JAN-2016
01-JAN-2017
A
COMPENSATION I
(CA)
01-JAN-2016
01-JAN-2017
A
EMPLOYERS
068022498
01-JAN-2016
01-JAN-201 7
A
LIABILITY
(FL)
01-JAN-2016
01-JAN- 2017
THE
068022491
PROPRIETOR/
(MN)
PARTNERS/
068022492
EXECUTIVE
(ME)
I
Statutory
WORKERS COM P LIMITS
EL EACH ACCIDENT
$5,000,000
EL DI SEASE - POL ICY LIMIT
$5 ,000,000
EL DISEASE ·EACH
$5 ,000,000
EMPLOYEE
OFFICERS ARE
Included
The Memorandum of Insurance serves solely to list insurance policies, limits and dates of coverage.
Any modifications here to are not authorized.
MEMORANDUM OF INSURANCE
I
DATE
28-Dec-2015
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://online.marsh.com/marshconnectpublic/marsh2/public/moi?client=null . 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.
Schneider Electric Holdings, Inc . (See below fo r Additional
("Marsh")
Named Insureds)
200 North Martingale Road
Suite 1000 , Schaumburg
Illinois
60 I 73
United States
ADDITIONAL INFORMATION
Waiver of subrogation is applicable on the General Liability, Auto Liability and Workers Compensation policies pursuant to
policy terms and conditions.
Deductible Amounts by line of coverage:
General Liability- $5,000,000
Automobile Liability- $2 ,000,000
Workers Compensation- $2,000,000
Workers Compenstion for MN only - $1 ,960,000
Professional Liability
11112016-1/112017
Limit: $10,000,000
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Memorandum of Insurance (MOI)
Page 3 of 9
Deductible:$5 ,000,000
Policy# : 03-205-10-99
Insurance Carner: Illinois National Insurance Co .
The following are Additional Nan1ed Insureds for the General Liability, Workers Compensation, Ohio Excess Workers
Compensation, Automobile Liability/Physical Damage & Umbrella Liability Policies:
Schneider Electric USA, Inc .
Schneider Electric Engineering Services, LLC
Veris Industries, LLC
Pro-Face America, LLC
Schneider Electric Motion USA, Inc.
Schneider Electric IT Corporation
Schneider Electric IT America Corp.
Schneider Electric IT USA, Inc.
Schneider Electric Buildings, LLC
Schneider Electric Buildings Americas, Inc .
Schneider Electric Buildings Critical Systems, Inc.
Pelco, Inc.
Schneider Electric Solar Inverters USA, Inc.
Schneider Electric Power Services, Inc.
Summit Energy Services, Inc.
Schneider Electric IT Mission Critical Services, Inc.
Schneider Electric Mobility NA, Inc.
Tel vent USA, LLC
Tel vent DTN, LLC
GRC Energy Support Services, LLC
Invensys Systems, Inc.
Invensys Systems, Inc ., dba Schneider Electric Systems USA, Inc .
Invensys Systems, Inc., dba Schneider Electric Systems USA
lndusoft, Inc.
InStep Software, LLC
AST North America, LLC
Schneider Electric Soll ware, LLC
ADDITIONAL WORKERS COMPENSATION COVERAGE:
1/1/2016-1/1/2017
Policy# : 068022496
Insurance Carner: New Hampshire Insurance Co .
Applicable States: IL, KY, NC, NH, UT, VT
Policy #:068022497
Insurance Carner: New Hampshire Insurance Co .
Applicable States: NJ, PA
Policy# : 068022495
Insurance Carner: New Hampshire Insurance Co .
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Memorandum of Insurance (MOI)
Applicable States: AZ, VA
Policy# : 068022494
Insurance Carrier: New Hampshire Insurance Co .
Applicable States: MA, ND, WA, WI, WY
Policy# : 068022490
Insurance Carrier: New Hampshire Insurance Co.
Applicable States: AL, AR, CO, CT, DC, DE, GA, HI, IA, ID, IN, KS, LA, MD, MI, MO, MS, MT, NE, NM, NV, NY, OK,
OR, RI, SC , SD, TN, TX, WV
OHIO ONLY EXCESS WORKERS COMPENSATION COVERAGE:
1/1/2016-1/112017
Policy #: 1103534
Insurance Carrier: National Union Fire Insurance Co.
LIMITS :
Each Accident: $3,000,000
Disease-Policy Limit:$3,000,000
Disease -Each Employee $3,000,000
Selfinsured Retention $2,000,000
Manuscript Endorsement
ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SCHEDULE:
I
Any person or organization for whom you are contractually bound to provide additional insured status but only to the extent of
such person or organization liability arising out of the use of a covered "auto" .
SECTION I - LIABILITY COVERAGE, A. Covernge, 1. - Who is Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured
under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person
or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto" .
However, the insurance provided will not exceed the lesser of:
(l) The coverage and/or limits of this policy, or
(2) The coverage and/or limits required by said contract or
agreement.
*COMMERCIAL GENERAL LIABILITY COVERAGE INCLUDES:
Commercial General Liability Form
Premises/Operations
Products/Completed Operations
Contractual Liability
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Memorandum of Insurance (MOI)
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Independent Contractors
Broad Form Property Damage
Personal Injury
Damage to Rented Premises
Cross Liability
Employers Liability
Severability oflnterests
Blended Pollution Endorsement 74437 ( 1/09) is included in the General Liability policy referenced above.
XCU Exclusion is not included in the General Liability policy referenced above.
Manuscript Endorsement
AMENDMENT OF LIMITS OF INSURANCE (PER PROJECT OR PER LOCATION AGGREGATE LIMIT)
This endorsement modifies insurance provided w1der the following :
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Per Project General Aggregate Li.nlit is $5,000,000 when required by written contract.
CG20 11 0413
ADDITIONAL INSURED MANAGERS OR LESSORS OF
PREMISES .
This endorsement modifies insurance provided Wlder the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
l. Designation of Premises (Part Leased to You): That part of any premises leased to you.
2. Name of Person or Organization (Additional Insured): Any person or organization as required by written contract with you
but only to the extent of that written contract with you.
3. Additional Premium: Included
SECTION II WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule bu
only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and
shown in the Schedule and subject to the following additional exclusions:
This insurance does not apply to :
1. Any "occurrence" which takes place after you cease to be a tenant in that premises.
2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization
shown in the Schedule.
CG 20 33 04 13
ADDITIONAL INSURED OWNERS, LESSEES OR
CONTRACTORS AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU .
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Memorandum of Insurance (MOI)
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This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II Who Is An Insured is amended to include as an additional insured any person or organization for whom you are
performing operations when you and such person or organization have agreed in writing in a contract or agreement that such
person or organization be added as an additional insured on your policy. Such person or organization is an additional insured
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.
A person's or organization's status as an additional insured under this endorsement ends when your operations for that
additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury" , "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to
render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders,
change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
2. "Bodily injury" or "property damage" occurring after:
a. 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
b. 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
san1e project.
ADDITIONAL INSURED AUTIIORIZED DISTRIBUTORS (VENDORS)
Endorsement #3 - Manuscript
This endorsement modifies insurance provided under the following :
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
1) Name Of Additional Insured Person(s) Or
2) Organization(s) (Vendor) Your Products
3) All Authorized Distributors of the Named Insured All products manufactured or sold by the Named Insured
A. Section II Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to
below as vendor) shown in U1e Schedule, but only with respect to "bodily injury" or "property damage" arising out of "your
products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business, subject to the
following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the asswnption of
liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the
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Memorandum of Insurance (MOI)
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absence of the contract or agreement;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor unless such change or modification is
accomplished by the rearrangement of existing components, parts or wiring and/or the addition or substitution of parts or kits
supplied by you and such change or modification was performed in accordance with instructions provided by you;
d. Repackaging, except when tmpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts
or modifications as described in l .c. above.
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in
cormection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of
any other thing or substance by or for the vendor; or
h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those
of its employees or anyone else acting on its behalf. However, this exclusion does not apply to:
(I) Tite exceptions contained in Sub-paragraphs d. or f. ; or
(2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the
usual course of business, in connection with the distribution or sale of the products.
2. This insurance does not apply to any insured person or organization that you have acquired such products from , or any
ingredient, part or container, entering into, accompanying or containing such products.
CG 20 15 04 13
ADDITIONAL INSURED VENDORS
(EXCEPT AUTHORIZED DISTRIBUTORS)
This endorsement modifies insurance provided under the following :
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
1) Name Of Additional Insured Person( s) Or
2) Organization(s) (Vendor) Your Products
3) All Vendors Except Authorized Distributors of the Named Insured
4) All Products Manufactured or Sold by the Named Insured
A. Section II Who ls An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to
below as vendor) shown in the Schedule, but only with respect to ''bodily injury" or "property damage" arising out of "your
produc ts" shown in the Schedule which are distributed or sold in the regular course of the vendor's business, subject to the
following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of
liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the
absence of the contract or agreement;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor;
d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts
under instructions from the manufacturer, and then repackaged in the original container;
_http~//on]jne. marsh..:.com/mars_!lconn~ctpub_!ic/!!!arsh2/pub_!ic/! ut/p/c5/dY3L UoMwGEafpQ_g_AnhU peBtjQ2iQJR02wYv IB AI ...
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Memorandum of Insurance (MOD
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e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in
connection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of
any other thing or substance by or for the vendor; or
h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those
of its employees or anyone else acting on its behalf. However, this exclusion does not apply to:
(I) The exceptions contained in Sub-paragraphs d. or f.; or
(2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the
usual course of business, in connection with the distribution or sale of the products.
2. This insurance does not apply to any insured person or organization that you have acquired such products from, or any
ingredient, part or container, entering into , accompanying or containing such products.
CG20100413
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 Person or Organization: Any person or organization as required by written contract; but only to the extent required by
that written contract with that person or organization, entered into with you and where permitted by law.
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:
I. 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 additionl 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 f1U11ished in c01mection with such work on the project (other than the
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 part of the same
project.
CG20 3704 13
ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: Any person or organization as required by written contract; but only to the extent required by
that written contract with that person or organization, entered into with you and where permitted by law.
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Memorandum of Insurance (MOI)
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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" .
CG24 04 10 93
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: Any person or organization as required by written contract; but only to the extent required by
that written contract with that person or organization, entered into wi th you and where permitted by law.
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (SECTION IV--CONDITIONS) is
amended by the addition of the fo llowing:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of
payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that
person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or
organization shown in the Schedule above.
Form 74434 (10/99)
ADDITIONAL INSURED - PRIMARY INSURANCE (and NON-CON1RIBUTORY)
This endorsement modifies insurance proivded under the following :
COMMERCIAL GENERAL LIABLITY COVERAGE FORM
Section IV, Commercial General Liability Conditions, paragraph 4., Other Insurance, subparagraph a. Primary Insurance, is
amended by the addition of the following:
However, coverage under this policy afforded to an additional insured will apply as primary insurance where required by
contract, and any other insurance issued to such additional insured shall apply as excess and noncontributory insurance.
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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