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Published by kerry.hendel, 2015-11-13 17:33:21

Test

Client#: 661838 CEPOWERS

ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

7/09/2015

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 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 CONTACT Debbie Neace
NAME:
USI Midwest Cincinnati
312 Elm Street,24th Floor PHONE Ext): 513 852-6417 FAX 610-537-4857
Cincinnati, OH 45202 (A/C, No, (A/C, No):

E-MAIL [email protected]
ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Valley Forge Insurance Company 20508

INSURED INSURER B : Continental Casualty Company 20443
INSURER C : Continental Insurance Company 35289
CE Power Solutions LLC
4040 Rev Drive INSURER D :
Cincinnati, OH 45232
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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)

A GENERAL LIABILITY C2087763928 12/01/2014 12/01/2015 EACH OCCURRENCE $ 2,000,000

X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000
PREMISES (Ea occurrence)

CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5,000

PERSONAL & ADV INJURY $ 2,000,000

GENERAL AGGREGATE $ 4,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000
$ 1,000,000
POLICY x PRO- LOC OH Stop Gap $1,000,000
JECT
$
C AUTOMOBILE LIABILITY C2087763931 12/01/2014 12/01/2015 COMBINED SINGLE LIMIT
(Ea accident)

X ANY AUTO BODILY INJURY (Per person)

ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS
AUTOS
X HIRED AUTOS
X NON-OWNED PROPERTY DAMAGE $
AUTOS (Per accident)

$

B X UMBRELLA LIAB X OCCUR C2087763945 12/01/2014 12/01/2015 EACH OCCURRENCE $9,000,000
$9,000,000
EXCESS LIAB CLAIMS-MADE WC288483814 AGGREGATE

DED X RETENTION $0 C2087763928 $
C2087763928
B WORKERS COMPENSATION C2087763931 12/01/2014 12/01/2015 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE $1,000,000
OFFICER/MEMBER EXCLUDED? N N/A E.L. EACH ACCIDENT

(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000

If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000

DESCRIPTION OF OPERATIONS below

A Leased Equipment 12/01/2014 12/01/2015 $500,000/$2,500 Ded

A Installation 12/01/2014 12/01/2015 $1,000,000/$2,500 Ded

C Hired Phy Damage 12/01/2014 12/01/2015 Unlimited/$1,000 Ded

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

Project: Any & All Work. Certificate holder is included as an additional insured under the general
liability per from G17957H 01.13; automobile per form CA2048 02.99 & umbrella (follow form) as required by
written contract/purchase order subject to policy terms/conditions on a primary & non contributory basis.
Waiver of subrogation is also included under the general liability per form CG2404 05.09; automobile per
form CA0444 03.10 & workers' compensation per form WC000313(as applicable by law) as required by
(See Attached Descriptions)

CERTIFICATE HOLDER CANCELLATION

ArcelorMittal LaPlace, LLC and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
all subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
138 Highway 3217 ACCORDANCE WITH THE POLICY PROVISIONS.
LaPlace, LA 70068-8821
AUTHORIZED REPRESENTATIVE

© 1988-2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD

#S15771529/M13789241 BXGZP

DESCRIPTIONS (Continued from Page 1)

written contract. Umbrella policy is follow form over the general liability, automobile & workers'
compensation.

SAGITTA 25.3 (2010/05) 2 of 2
#S15771529/M13789241





POLICY NUMBER: COMMERCIAL AUTO
CA 20 48 02 99

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED INSURED

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-
sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indi-
cated below.

Endorsement Effective: Countersigned By:

Named Insured: (Authorized Representative)
Name of Person(s) or Organization(s):
SCHEDULE

(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to the endorsement.)

Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained
in Section II of the Coverage Form.

CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 o

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POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization:

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:

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.

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 †

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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN
THIS WAIVER OF OUR RIGHT TO RECOVER FROM UNDER A WRITTEN CONTRACT
OR AGREEMENT. THIS ENDORSEMENT DOES NOT APPLY IN KY.

00020001420884838141818

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium $

Insurance Company Countersigned by

WC 00 03 13 Copyright 1983 National Council on Compensation Insurance.
(Ed. 4-84)

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