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AC(7RG1® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MN18 YVYV)
<br />n/2v2D1e
<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
<br />CONTACT
<br />NAME:
<br />PHONE fN C No
<br />---
<br />Philadelphia, PA 19103-2797
<br />Attn: NBCU.Cerbequest@mamh.cem Fax 212-948-5143
<br />E-MAIL -
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICA
<br />INSURER A : ACE American Insurance Company
<br />22667
<br />298523-NBCU-CAS: 18-19
<br />INSURED
<br />NBCUniversal Media, LLC
<br />INSURER B : Indemnily Ins Co Of North America
<br />43575
<br />INSURER C : ACE Property And Casualty Ins Co
<br />20699
<br />a fully awned subsidiary of Comcast Corporation
<br />to include but not limited to National Center for Safety Initiatives LLC
<br />DBA Southeastern Security Consultants
<br />INSURER D : ACE Fire Underwriters Ins. Co.
<br />20702
<br />30 Rockefeller Plaza
<br />INSURER E:
<br />Neal York, NY 10112
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CLE-00632123MB RFVISION NIIMRFR• 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 INBURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERALLUIBIUTY
<br />CLAIMS -MADE 111 OCCUR
<br />XSLG71209313
<br />12/01/2018
<br />12/0112019
<br />EACH OCCURRENCE
<br />$ 4,900,000
<br />DAMA E T RENTED
<br />PREMISES Ea occurrence)
<br />$ 4,900,000
<br />X
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />SIR: $100,000
<br />PERSONAL a ADV INJURY
<br />$ 4,900,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />X ❑ PRO -
<br />POLICY JECT ❑ LOC
<br />GENERALAGGREGATE
<br />$ 25,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 6,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ISAH25275354
<br />12/0112018
<br />12/0112019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 10,000,000
<br />X
<br />BODILY INJURY (Par person)
<br />If
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />XOO G27924840004
<br />12/01/2018
<br />12/01/2019
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />A
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN ANYPROPRIETOR/PARTNER/EXECUIVE
<br />OFncER/MEMBEREXCLUDEDT ❑N
<br />(Mandatory In NH)
<br />N/A
<br />WLRC65440398(ADS)
<br />WLRC6544043A (CA, MA)
<br />SCFC65440519 I
<br />(W)
<br />1210112018
<br />1210V2018
<br />12101/2019
<br />12/01I2019
<br />12/01/2019
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />FL DISEASE - EA EMPLOYEE
<br />$ 2,000,000
<br />B yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 2,000,000
<br />A
<br />Excess Workers Compensation
<br />WCUC65440477(WA)
<br />12/01/2018
<br />12I01/2019
<br />Ea Acc/Dis Employee/Dis Polic
<br />2,000,000
<br />SIR
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS r 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 />NBCUnivemal Media, LLC subsidiaries include, but are not limited to: SportsEngine
<br />City of Santa Ana
<br />Attn: Tania L Knauefhaze
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />of Marsh USA Inc.
<br />Manashi Mukherjee ._Vataune "
<br />All rights reaervad_
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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