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Client#: 475947
<br />Digitally signed by
<br />Francine R.
<br />R. Villareal
<br />ALLCITYMAN\/illarnal Date: 2021.08.0416:24:03
<br />ACORDT1,1 CERTIFICATE OF LIABILITY INSURANCE
<br />'DATE (MM/DD/YYYY)
<br />08/04/2021
<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
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Nick Newell
<br />NAME:
<br />Marsh & McLennan Agency LLC
<br />aHON o, 949 425 7312 FAX
<br />Marsh & McLennan Ins. Agency LLC
<br />El : No):
<br />E-MAIL ADDRESS: nick.newell@marshmma.com
<br />1 Polaris Way #300
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Aliso Viejo, CA 92656
<br />INSURER A: Landmark American Insurance Company
<br />33138
<br />INSURED
<br />INSURER B : Mercer Insurance Company
<br />14478
<br />All City Management Services, Inc.
<br />Lexington Insurance Company
<br />INSURER C : g p y
<br />19437
<br />10440 Pioneer Blvd., Suite 5
<br />Berkshire Hathaway Homestate Ins Co
<br />INSURER D : Y
<br />20044
<br />Santa Fe Springs, CA 90670
<br />INSURER E : esesSurplus Westchester Slus Lines Insurance Co
<br />110172
<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
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />LHA141591
<br />8/01/2021
<br />08/01/2022
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE L* OCCUR
<br />PREMISES (ERENTED
<br />nte)$50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$5,000,000
<br />POLICY /► JECOT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />20000000182
<br />8/01/2021
<br />08/0112022
<br />EACH OCCURRENCE
<br />$3 00U 000
<br />AGGREGATE
<br />s3,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? NI
<br />(Mandatory in NH)
<br />N / A
<br />ALWC238792
<br />01/01/2021
<br />01/01/2022
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<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 />C
<br />Excess Liability $1mil xs $4mil
<br />080877908
<br />08/01/2021
<br />08/01/202
<br />$1,000,000 Each Occ. & Aggregate
<br />E
<br />Excess Liability$5mil xs $5mil
<br />G72535522001
<br />08/01/2021
<br />08/01/2022
<br />$5,000,000 Each Occ. & Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as additional insured as
<br />respects to General Liability per attached endorsement. Primary and Non -Contributory
<br />Wording applies per attached endorsement. Cancellation provisions apply per the attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />y
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />20 Civic Center Plaza, 4th Floor
<br />ACCORDANCE WITH THE POLICY
<br />PROVISIONS.
<br />Santa Ana, CA 92701-0000
<br />AUTHORIZED REPRESENTATIVE
<br />RAManagmerd DiVisian
<br />REVIEWED & APPROVED BY:
<br />P1' v'd
<br />1988-2015 ACORD(
<br />ACORD 25 (2016/03) 1 of 1 The ACORD name and logo
<br />are registered marks of ACORD
<br />Risk Management Analyst
<br />#S8560795/M8560794
<br />
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