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4CORD ULK 11HUA I t Ur LIAMLI I Y IIVSUKANL;t 01/26/2021 <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 BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate <br />does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />PAYCHEX INS AGENCY INC <br />150 SAWGRASS DR <br />ROCHESTER, NY 14620 <br />362.6785 <br />872.8921 <br />ADDRESS: paychex@travelers.com <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br />INSURED <br />AMERICA ON TRACK <br />600 W SANTA ANA BLVD <br />STE 710 <br />SANTA ANA, CA 92701 <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSTR <br />_TR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MWDD/YYYY) <br />POLICY EXP <br />(MWDD/YYYY) <br />LIMITS <br />EACH OCCURRENCE <br />DAMAGE TO RENTED <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence) <br />CLAIMS -MADE = OCCUR <br />MED EXP (Any one person) <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO <br />POLICY ❑ JECT ❑ LOC <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE <br />OTHER: <br />PRODUCTS - COMP/OPAGG <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) <br />OWNED SCHEDULED <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />(Per accident) <br />$ <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE <br />DED RETENTION $ <br />$ <br />F] <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />WA <br />UB-3L272199-21-42 <br />01/01/2021 <br />01/01/2022 <br />X <br />PER <br />STATUTE <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N <br />OFFICER/MEMBER EXCLUDED? El <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />20 CIVIC CENTER PLAZA BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />M25 ACCORDANCE WITH THE POLICY PROVISIONS. <br />SANTA ANA, CA 92701 Al ITI IP17rn RFDRFCFNTAT1%/F <br />`/V/ r lydwrllm <br />IZAMwagzmedDMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />