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.�-Zozn 12� <br />/ I T <br />R CERTIFICATE OF LIABILITY INSURANCE <br />DATE,2019 YYYY) <br />�� <br />1,. <br />oenmols <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(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 lieu of such endorsement(s). <br />PRODUCER <br />MARSH USA INC. <br />540 W. MADISON <br />CHICAGO, IL 60661 <br />CONTACT <br />NAME: <br />PHONE FAX <br />l!1 Arc Noll <br />DDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />tbo-S1dCrCyP-19L20 <br />INsuRERA: MOsui Sumitomo Insurance CD. OfAmelica <br />20362 <br />INSURED NEC Corpora0on of America <br />INSURER B: Mitsui Sumitomo Insurance USA, Inc. <br />22551 <br />INSURER c: N/A <br />NIA <br />3929 W. John Carpenter Freeway <br />Irving, TX 75063 <br />INSURER p: <br />INSURER E: <br />_ <br />INSURER F: <br />e.v YCRAGES CERIO-IGATE NUMBER' CHI-nm'U1950W. eeurmnu wiuevn..e <br />___--________ ........... n..,nuc,.. .a <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 />LT <br />TYPE OF INSURANCEADOL <br />SUB <br />POLICY EFF POLICY EXP <br />POLICY NUMBER IMMIDDINY"Y'rl LIMITS <br />A <br />% <br />commERCIALGENERgL LIABLLITY <br />PKG3101192 07/01/2019 07101Y2020 EACHOCCURRENCES <br />LODO,000 <br />CLAIMSMADE OCCUR <br />S 1,000,WO <br />PREMISES Ea oavrience <br />S 10,000 <br />MED EXP (Arty onsperson) <br />5 1,000,U0O <br />PERSONAL a ADV INJURY <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY 1 <br />g 2.000,000 <br />GEN'L <br />GENERALAGGREGATE <br />5 2,000.0OD <br />JECT LOC <br />PRODUCTS-COMP/OPAGG <br />O'DiER <br />r <br />g <br />B <br />AUTOMOBILELWBILRY <br />_ <br />BVR8304045 <br />D710112019 07,01/2020 - COMBINED <br />BINEDl INGLE LIMB <br />$ 1000000 <br />X <br />ANY AUTO <br />S <br />. BODILY INJURY (Per person) <br />! <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per eWdaccused)S <br />% <br />HIRED X NOWMNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGEPer accident)S <br />5 1.000 <br />!I <br />COMP/COL L DED. <br />X <br />UMBRELLA LOB <br />X <br />JOCCUR <br />UMB5000517 0711OV2019 <br />'07/0112020 <br />EACH OCCURRENCE <br />S 5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />g 5,01)0.000 <br />DED RETENTIONS <br />$ <br />A <br />WORKERS COMPENSATION <br />WCP9115732 I <br />7MI <br />% , PER OTR - <br />A <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER <br />E.L EACH ACCIDENT <br />g 1,000,WO <br />ANYPROPRIETORIPARTNER)EXECUTIVE <br />WCP9115734 (WI) 07/01/2019 <br />O7N1/2020 <br />A <br />OFFICERIMEMBEREXCLUDED? [flNIA <br />(Mandatory In NH) <br />WCP9115733(NEC Laboratories D7ro112079 <br />07101020 <br />E.L DISEasE-EA EMPLOYE <br />s 1.000,00) <br />Ifyw describe under <br />•ef America Inc.)" <br />E.L. DISEASE -POLICY LIMIT <br />S 1.000.000 <br />DESCRIPTION OF OPERATIONS Ml. <br />i <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addieonsl Rem ZSchedule, may be a0ached if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as addifbna insured on this policy pursuanl to written contract, agreement, or memorandum of understanding. Such insurance as is affords: <br />by this policy shall be primary, and any insurance carried by City shall be excess and noncontrioutory. <br />& APPROVED <br />CERT lFiCAIG HOLDER FAV ICICN WIANADFMFNT DIVISION rAMCCf I ATInu <br />City of Santa Ana 1320119 <br />Risk Manage ment Division <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plazalc�o <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92707 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />SAMA HA M. LAMBERT <br />gUTHORDFD REPRESENTATIVE <br />of Marsh USA Inc, <br />Manashi Mukherjee —TwLeuu " �lµte.eLana.eA. <br />©1988.2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016)03) The ACORD name and logo are registered marks of ACORD <br />