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Ac"Rb® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 0911812018 " "'
<br />2018
<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 />1717 Arch Street N-2018-189
<br />Philadelphia, PA 19103-2797
<br />Ahm NBCU.Certrequest@marsh.com Fax 212-948-5143
<br />CONTACT
<br />NAME:
<br />PHONE q C No
<br />E-MAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICN
<br />INSURER A: ACE American Insurance Company
<br />22667
<br />298523-NBCU-CAS.17-18
<br />INSURED
<br />NBCUniversal Media, LLC
<br />INSURER B: Indemnity Ins CO Of North America
<br />43575
<br />INSURER c : ACE Property And Casualty Ins Co
<br />20699
<br />a fully owned subsidiary of Concept Corporation
<br />INSURER D : ACE Fire Underwriters Ins, Co.
<br />20702
<br />to include but not limited to National Center for Safety Initiatives LLC
<br />I Southeastern Security Consultants
<br />30 Rockefeller Plaza
<br />INSURER E : Agri General Insurance Company
<br />42757
<br />New York, NY 10112
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: CLE-006321239-04 REVISION NUMBER: 6
<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 />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDM'YY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />XSLG27871252
<br />12/01/2017
<br />12/01/2018
<br />EACH OCCURRENCE
<br />$ 4,900,000
<br />CLAIMS -MADE 7X OCCUR
<br />PREMSES Ea occurrence)
<br />$ 4,900,000
<br />X
<br />MED EXP Any one person)
<br />$ 10,000
<br />SIR',$100,000
<br />PERSONAL &ADV INJURY
<br />$ 4,900,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />POLICY ❑ PRO- ❑
<br />JECT LOG
<br />GENERALAGGREGATE
<br />$ 25,000,000
<br />GEN'L
<br />X
<br />PRODUCTS-COMP/OP AGE
<br />$ 6,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ISAH09063407
<br />12/01/2017
<br />12/01/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 10,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />id Per accent
<br />BODILY INJURY ( )
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per acoitlent
<br />$
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />XOO G27924840003
<br />12/01/2017
<br />12/01/2018
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />A
<br />D
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYE RS'LIABILITY
<br />ANYPROPRIETOWPARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBEREXCLUDEO?
<br />(Mandatory in NH)
<br />If yea, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WLRC64618933(AOS)
<br />WLRC64618945 (CA,MA)
<br />SCFC64618957(WI)
<br />WLRC64610969 (TN)
<br />/
<br />12/01/2017
<br />12/01/2017
<br />12I0112017
<br />12/01/2018
<br />12I0112018
<br />12/01/2018
<br />12101I2018
<br />g PER DTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 2,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 2,000,000
<br />A
<br />Excess Workers Compensation
<br />W00064618970
<br />12/01/2017
<br />1210l/2018
<br />Ea Acc/Dis Employee/Uis Polic
<br />2,000,000
<br />SIR
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: Exhibition Booth
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and volunteers are named as additional Insureds ('additional insureds") with regard to liability and defense o
<br />suits arising from the operations and uses performed by or on behalf of the named insured (except for Workers' Compensation) where required by written contract
<br />NBCUniversal Media, LLC subsidiaries include, but are not limited to: SportsEngine
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attn: Tania L Knauerhaze THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />P.O Box 1988 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manachl Mukherjee .-Prt.cti�1.,L w}Yfw.dL>\.c el
<br />@ 1988.2016 ACORD CORPORATION. All rights r erve
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ��°��
<br />
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