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ACC OR <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (YY) <br />9/s/z/5/2"�'D°Y" <br />019 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN <br />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 be <br />provisions or endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. <br />A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsements I. <br />PRODUCER <br />C CT <br />MdiBh USA, INC. <br />NAME: _. Charter Risk Management <br />701 Market Street, suite 1100 <br />— <br />PNONE 'FAX <br />St. Louis, NO 63101 <br />AQ E5_1:. certificaterequeste®charter.com <br />INSURE 8 AFFORDING COVERAGE <br />CbAPANY A: Nat one on re Ins o i"SSurgTi Pam— <br />NAICe <br />— ... _ _ _ <br />19445 <br />_ <br />INBURED <br />Charter Communications, Inc. <br />COMPANY B: New Hampshire Ineurance Company <br />23941 <br />M AN'Y C: Comnarce an n ustry Insurance Company <br />19410 <br />400 Atlantic Street <br />Stamford, CT 06901 <br />AN ce Proper y s-Caaua Ly Insurance company <br />20699 <br />COMPANY e: AIU Ineurance Compeny------'— <br />19 9 <br />COMPANY F: American Home Assurance Company <br />19380 <br />COVERAGES cconcvnrc unsm�... anc»v <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED <br />VISION <br />TO THE INSURDENAMED ABOVEBFOR <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION <br />CERTIFICATE MAY BE ISSUED OR <br />OF ANY CONTRACT OR OTHER <br />THE <br />DOCUMENT WITH RESPECT <br />POLICY PERIOD <br />TO WHICH THIS <br />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 <br />W9R ADDL <br />-P <br />PAID CLAIMS. <br />LTR TYPEOF WSURANCE SR <br />POLICY NUMBER <br />LK:Y EFF POLICY EXP <br />'-------- <br />C X CONMERCUILGENERALLIABILPY <br />GL 3629906 <br />1/1/2019 <br />/OD <br />l/l/2020 <br />LIMR9 <br />EACH OCCURRENCE <br />$ <br />$1,000,000 <br />CLAIMS -MADE n OCCUR <br />AWN EE <br />PREMISES Ea ne <br />$ <br />$500, 000 <br />_j <br />X <br />MED EXP Anyone on) <br />$ <br />$30, 000 <br />PERSONALSADV INJURY <br />S <br />$1, 000, 000 <br />— <br />GEN'L AGGREGATE LIMn APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />3, 000, 000 <br />j� <br />R POLICY �jEC <br />PRODUCTS-COMP/OP AGO <br />$ <br />$3, 000, 000 <br />`JLOC <br />OTHER: <br />OM NEED SI LE LIMIT <br />$ <br />1,0 0, 000 <br />A AUTOMOWLELIABILIIY <br />A "l <br />CA 1921838 (ADS) 1/1/2019 1/1/2020 <br />A X At1T0 <br />CA 1921839 (MA) <br />Ea ealtlan0 <br />$ <br />JANY <br />OWNED SCHEDULED <br />CA 1921840 (VA) <br />1/1/2019 <br />1/1%2020 <br />BODILY INJURY (Per person) <br />$ <br />— — <br />AUTOS ONLY AUTOS <br />HIRED NO"AUTOS NED <br />BODILY INJURY (Per acadent ) <br />S <br />_. AUTOS ONLY AUTOS ONLY <br />LY <br />PROPERTY DAMAGE <br />r acdtlentl <br />$ <br />-- <br />D _X UMBRELLALIAB OCCUR <br />G28119616 004 :/1/2019 3/1/2020 <br />EXCESS LIAB <br />EACH OCCURRENCE <br />S <br />' <br />�_.. CLgIMS-MAOE� <br />'AGGREGATE <br />' <br />OED RETENTION <br />R OTH. <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILTIY <br />See second pace Eor °/1/2019 I/1'2020 <br />Y/N <br />AFFICE EMBR/PARTNERIE%ECUNVE <br />RE%CLUOE07 ® NIA <br />policy <br />information. <br />information. <br />-/1/2019 <br />1/l/2019 <br />1/l/2020 <br />1 /1/2020 <br />ST TUTE ER <br />E,L EACH <br />_ <br />$5,000, <br />Mandatory <br />(Mandatory In NH) <br />InN <br />Ryes,IPTION undo' <br />: /1/2019 <br />-/3/2019 <br />1/1/2020 <br />1Ji/2020 <br />ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />000 <br />—�5'D00,000 <br />DESCRIPTION OF OPERATIONS below <br />1/l/2019 <br />'1/l/2020 'E.L. <br />$5, 000, 000 <br />S IExcess NC OH ($SM Retention) <br />XWC 45955666 (QSI OH) <br />./1/2019 <br />DISEASE -POLICY LIMIT <br />S <br />F1 Id020 <br />i <br />Employers, Liability <br />$s,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD161,Addiennal Remmusumdula, <br />maybeetbdlatl NmoreepagisnaA"dJ <br />Please see page 2 for additional insureds and any additional <br />language. <br />CERTIFICATE HOLDER <br />.....__.. -_._.. <br />City of Santa Ana Risk MaP3p <br />20 Civic Center Plaza KE <br />Santa Ana, CA 92702 ABy <br />131019 <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 />AUTHORIMI)REPRESENTATIve �I <br />Tosepn M. Lee )"�o r'/ /�y// /a <br />©1988-2016 ACORD CORPORATION. All rights reserved, <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />