|
Francine R. oi�yvow�mr�.�a
<br />Villareal o.aanai
<br />® CERTIFICATE OF LIABILITY INSURANCE
<br />D^;E92020DYYYY)
<br />1t.i
<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 />CONTACT
<br />NAME:
<br />Marsh USAlnc.
<br />FAX
<br />NNa
<br />1717 Arch Strad
<br />AHC Ent,(A/C, No):
<br />E-MAIL
<br />ADDRESS:
<br />Philadelphia, PA 19103-2797
<br />Atb: NBCU.Certrequest@mamh.com Fax 212-948-5143
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICN
<br />INSURER A : ACE American Insurance Company
<br />22667
<br />CN10160851 SNBCU-GAWUW-20-
<br />INSURED NBCUniversal Media, LLC
<br />INSURER B : Indemnity Ins Co Of North America
<br />43575
<br />INSURERC: ACE Property And C asualty Ins Co
<br />20699
<br />a fully owned subsidiary of Comcast Corporabon
<br />30 Rockefeller Plaza
<br />INSURER D : ACE Fire Underwriters Ins. Co.
<br />20702
<br />NewYork,NY 10112
<br />INSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CLE-006533573-04 REVISION NUMBER: 8
<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 />R
<br />OF INSURANCE
<br />ADDTYPE
<br />INSD
<br />WVDSIUBR
<br />POLICYNUMBER
<br />POLICY
<br />MMIDY DVYV
<br />POLICY
<br />Y MMDDVYV
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />XSLG71447510
<br />12/01/2020
<br />12/012021
<br />EACH OCCURRENCE
<br />$ 14,900,000
<br />CLAIMS -MADE IX I OCCUR
<br />PREMISES Ea occurrence
<br />$ 14,900,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />SIR: $100,000
<br />PERSONAL B ADV INJURY
<br />$ 14,900,000
<br />GEML
<br />AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE
<br />$ 60,000,000
<br />POLICY PRO ❑
<br />EDT LOG
<br />X
<br />PRODUCTS - COMPIOPAGG
<br />$ 15,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />ISA H25305590
<br />12/01/2020
<br />12/012021
<br />COMBINED SINGLE LIMIT
<br />Ea accident'
<br />$ 15,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY(Per accident)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />XEU G27924840006
<br />12/01/2020
<br />12/012021
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />A
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />RIIMEMBER EXCLUDED' N
<br />(Mandatory in NH)
<br />NIA
<br />WLR C67458928(ADS)
<br />WLR C67458965 (CA, MA)
<br />SCF C67459040(INI)
<br />12Po1/2020
<br />12/01/2020
<br />12/012021
<br />12/012021
<br />12/012021
<br />OT
<br />X PER H-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />2,000,000OFFIC
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 2,000,000
<br />f yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L DISEASE -POLICY LIMIT
<br />2,000,000
<br />$
<br />A
<br />Excess Workers Compensation
<br />WCU C67459003(INA)
<br />12/01/2020
<br />12/012021
<br />Ea Acc/Dis Employee/Dis Polic
<br />2,000,000
<br />SIR
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEH IC LES (AC 0RD 181, Additional Remarks Schedule, may be attached if more space is required)
<br />RE'. Service Contract between SportsEngine Inc. - NCS I and City of Santa Ana, CA
<br />NBCUniversal Media, LLC subsidiaries include, but are not limited to Sports Engine Inc. dips National Center for Safety 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 />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, 4th floor ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />MariMukherjee _Sz[n,! WskMRnagemerdDivildot
<br />REVIEWED & APPROVEDBY:
<br />© 1988.2016 ACORD C Z. (1,Q
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD '�' Risk Management Analyst
<br />
|