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Dgiully,igned r, F Ira,
<br />Francine R. Villareal vii—el
<br />pare: mm.aen IM nwurar
<br />` cc> o CERTIFICATE OF LIABILITY INSURANCE
<br />DAT71202DDn rvvl
<br />gam7n9zo
<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 />Philadelphia, PA 19103-2797
<br />Alin: NBCU.Ceorequest@marsh.com Fax 212-948-5143
<br />CONTACT
<br />NAME;
<br />PHONE FAK
<br />Exit
<br />N. A/C No:
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICS
<br />CN701608515-NBCU-GAWUW-19-
<br />INSURER A: ACE American Insurance Company
<br />22667
<br />INSURED NBCUnivemal Media, LLC
<br />INSURER B: Indemnity Ins Co Of North America
<br />43S75
<br />INSURER C: ACE Property And Casualty Ins Cc
<br />20699
<br />a fully owned subsidiary of Comcast Corporation
<br />30 Rockefeller Plaza
<br />New York, NY 10112
<br />INSURER D: ACE Fire Underwriters Ins. Co,
<br />20702
<br />INSURER E:
<br />INSURER F:
<br />C_GVERAbCJ IaK I ]FICA I NDMFPR' CIF-nnR53.m J,Lm DOLnclnsd anlnnecca. c
<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 INSURANCE
<br />ND —DI
<br />=
<br />POLICYNUMBER
<br />MM/U�IYEYYV
<br />POLICYXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />M OCCUR
<br />SIR: $100,000
<br />XSLG7144756A
<br />12101/2019
<br />12JW(2620:
<br />EACH OCCURRENCE
<br />$ 9,900,000
<br />—RENTED
<br />-UAMCLAIMS-MADE
<br />PREMISES
<br />PREMISES Ea occurrence
<br />Ea occurrence)
<br />$ 9,900,000
<br />X
<br />MED EXP(Any one person)
<br />$ 10,000
<br />PERSONAL 3 ADV INJURY
<br />$ 9,900,000
<br />AGGREGATE LIMIT APPLIES PER
<br />POLICY ❑ JEST LOG
<br />GENERALAGGREGATE
<br />$ 40,000,000
<br />GENT
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 10,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ISAH25285438
<br />1210t12019
<br />12/01I2020
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 10,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />NON -OWNED
<br />ONLY AUTOSONLY
<br />(Per actldent)
<br />$HIRED
<br />Y DAMAGEAUTOS
<br />ent
<br />$X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />XOO G27924840005
<br />1210112019
<br />VJ0112020
<br />CURRENCE
<br />s 10,000,000EXCESS
<br />W(PerJURY
<br />$ 10,000,000BEO
<br />LIAB
<br />CLAIM'-MADEATE
<br />RETENTION$
<br />$WORKERS
<br />COMPENSATION
<br />ANDEMPLOYERS'LIABILRY YIN
<br />in NH)
<br />If yes, describe under
<br />NIA
<br />WLRC66040677(ADS)
<br />WLRC66040719(CA, MA)
<br />SCFC66040793(WI)
<br />121112019
<br />1MI12019
<br />1210112019
<br />12/01/2020
<br />1210112020OFFICERIMEMBEREXCLUDED1
<br />12/01/2020
<br />OTH-
<br />TUTE ERAANYPROPRIETORIPARTNERIEXECUT1VE
<br />ACCIDENT
<br />$ 2,000,000(Mandatory
<br />ASE-EA EMPLOYE
<br />$ 2,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />Lie
<br />$ 2,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Excess Workers Compensation
<br />WCUC6604W56 (WA)
<br />1210112019
<br />12101/2020
<br />Ea Accf[As Employee/Dis
<br />2,000,000
<br />SIR
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Addltlanal Remarks Schedule, maybe attached if more space is required)
<br />RE: Service Contract between SpodsEngine Inc. -NCSI and City of Santa Ana, CA
<br />NBCUniversal Media, LLC subsidence include, but are not limited to: Spore Engine Inc. dba National Center for Safely Initiatives LLC
<br />The Certificate Holder is included as additional insured (except workers' compensation) where required by written contract with the Named Insured. This insurance is primary and non-contributory over any existing
<br />insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Please see attached for Notice of Cancellation endorsements.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee �a-lylyl
<br />988.2016 ACORD CI
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />Rtakfilanage 1entDiviabin 9x.
<br />REVIEWED S APPROVED BY
<br />I� Risk Management Analyst01
<br />y
<br />
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