|
Digitally signed by Tori Pierson
<br />To r i Pierson Date: 2022.04.05 1126:44
<br />-07'00
<br />ALC"R�®
<br />v CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/04/2022 Y)
<br />04/04/2022
<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 />McGriff Insurance Services, Inc.
<br />P.O. Box 10265
<br />CONTACT grid ette Taul
<br />NAME: g
<br />A/CC No Ext : 800 476-2211 PHONE FAX
<br />No):
<br />Birmingham, AL 35202
<br />E-MAIL riff.comlaume
<br />ADDRESS: bt@ g
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA :The Charter Oak Fire Insurance Company
<br />25615
<br />INSURED
<br />ARC Document Solutions, Inc.
<br />INSURER B :Travelers Property Casualty Company of America
<br />25674
<br />INSURER C :The Travelers Indemnity Company
<br />25658
<br />345 Clinton Street
<br />Costa Mesa, CA 92626
<br />INSURER D :The Travelers Indemnity Company of Connecticut
<br />25682
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:6U4RSSE2 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
<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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE F_x1 OCCUR
<br />P6307R80315ACOF22
<br />Travelers Property Casualty
<br />Company of America is GL insurer for
<br />the State of CA
<br />02/26/2022
<br />02/26/2023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />X
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY JECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />8107R8493842243G
<br />02/26/2022
<br />02/26/2023
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />x
<br />HIRED IXNON-OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />B
<br />X
<br />UMBRELLA LABX
<br />OCCUR
<br />CUP7R9404682243
<br />02/26/2022
<br />02/26/2023
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION $
<br />$
<br />B
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />UB2L7502842251 K (AOS)
<br />UB2L6010822251 R (AZ, MA, WI)
<br />02/26/2022
<br />02/26/2023
<br />X SPER TATUTE OTH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<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 />Re: Reprographic Services.
<br />City of Santa Ana, its officers, agents and employees are Additional Insured under General Liability which applies on a primary and non-contributory basis as required by
<br />written contract. In the event of cancellation by the insurance companies, the policies have been endorsed to provide 30 days notice of cancellation (except for non
<br />payment) to the certificate holder as required by written contract. General Liability coverage contains Separation of Insureds as provided by policy wording.
<br />CERTIFICATE HOLDER
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92701
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED PC �, �I & ARFRa DST.
<br />THE EXPIRATION DATE THEREOF, NOT "�7x qrs
<br />ACCORDANCE WITH THE POLICY PROVISION
<br />., Risk Management Clerical A de
<br />AUTHORIZED REPRESENTATIVE „r 7 �r r
<br />ACORD 25 (2016103)
<br />Page 1 of 8 © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|