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<br />A`� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE�0r;'9°"W"
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POIiCy(les) 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 (feu of such endorsements .
<br />PRODUCER
<br />MARSH USA INC.
<br />540 W. MADISON
<br />CHICAGO, IL 60661
<br />CONTACT
<br />NAME: _
<br />PHONE i FAX
<br />MAILo Err I INC No),
<br />APDRIESS,
<br />INSURERS AFFORDING COVERAGE
<br />Ni
<br />tW-Std-Cr1i _
<br />INSURER A: Mitsui Sumitomo Insurance Co. Of America
<br />20362
<br />INSUREDNEC Corporation of America
<br />INSURER B: Mllsui Sumitomo Insurance USA, Inc.
<br />22551
<br />INSURER C : NIA
<br />WA
<br />3929 W. John Carpenter Freeway
<br />Irving, TX 75W3
<br />-
<br />INsuaeR °
<br />INSURER E:
<br />INSURER F;
<br />COVERAGES CERTIFICATE NUMBER- CHL°05a112545-nR MFVIQi MI IIU1xi 13
<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 />WBR
<br />TYPE OF INSURANCE
<br />POLICY EFF
<br />POLICY NUMBER MMIO
<br />POLICY EXP
<br />MWDO
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CWMS-MApE [ OCCUR
<br />PKG3101192 07/01/2019 07/0112020
<br />s 1,000.000
<br />DAMAGETRENCE
<br />.Eorcueence
<br />S 1,000,000
<br />ME(An One parson)
<br />S 10,000
<br />ADVINJURY
<br />MD
<br />B 1.000,000DEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />JECT LOCCOMP/OP
<br />GREOATE
<br />$ 2,000,000POLICY
<br />AGG
<br />a 2.000,000
<br />S
<br />OTHER:
<br />B AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />.OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />K HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />BVR8304045
<br />0710112019
<br />!07101/2020
<br />COMBINED SINGLE LIMIT
<br />Ea a dent
<br />s 1,000,000
<br />BODILY INJURY (Par parson)
<br />S
<br />BODILY INJURY (Per accident).
<br />S
<br />PROPERTY DAMAGE
<br />per uq qn
<br />S
<br />GOMPICOLL DED.
<br />a 1,0Dg
<br />%
<br />UMBRELLAUAa
<br />X
<br />OCCUR
<br />UMB50D0517
<br />07/0112019
<br />�07/0112020
<br />EACHOCCURRENCE
<br />S 5,000.000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS UAB
<br />I
<br />I CLAIMS -MADE
<br />DED I I RETENTION
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' UAeILT'
<br />ANYPROPRIETORIPARTNERlEXECUTIVE YIN
<br />OFFICERIMEMBEREXCIL ED?
<br />In NH)
<br />Ify 6deacdbeunder
<br />TH-
<br />ER
<br />$
<br />A
<br />A
<br />A
<br />NIA(Mandatory
<br />�WCP9115732
<br />'WCP9115734(WI)
<br />WCP9115733 (NEC Laboratories
<br />"of America Inc.DEBCRIPTIONOFOPERATIONSbalau %
<br />I
<br />0710112019
<br />0710112019
<br />0710112020
<br />07101,2020
<br />07ID112020
<br />EACH NT
<br />$1,W0,000
<br />=AOCDErW4TyL.MT,
<br />EMPLOYEE
<br />S 1,000,000
<br />CY LIMIT
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached a more space Is required)
<br />Cry of Santa Ana, officers, agents, employees, and volunteers are named as additional insured on this policy pursuant to written contract, agreement or memorandum of understanding. Such Insurance as is affordec
<br />by this policy Shall be primary, and any insurance carved by City shall be excess and noncontroubry.
<br />REVIEWED & APPROVED
<br />CERTIFICATE HOLDER PtV RIS ANA EMENT DiViSION CANCELLATION
<br />City of Santa Ana 13 2019
<br />Risk Mani, ant Division
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SA THA M. LAMBERT
<br />AUTHORIZED REPRESENTATIVE
<br />,561 p
<br />)13 1
<br />of Mann USA Inc.
<br />y
<br />Manashi Mukhedee _YstcLuaos.,: _W_Cac�
<br />©1988.2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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