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rrancine H. Villareal "Ilereal
<br />A� �® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 1;20Z;
<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 />1050 CONNECTICUT AVENUE, SUITE 700
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />o Ext: A/C No:
<br />ADDRESS:
<br />WASHINGTON, DC 20036-5386
<br />AUn: Danaher.cedrequest@marsh.com Fax (212) 948-0503
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: ACE American Insurance Company
<br />22667
<br />CN102997607-ALL.711:21-22 SEDAR
<br />INSURED SEDARU, INC.
<br />INSURER B: ACE Property and Casual) an Insurance Com
<br />20699
<br />INSURER C: [ndemnty Ins Cc Of North America
<br />43575
<br />168 ARROW HWY, SUITE 101
<br />INSURER D : ACE Fire Underwriters Insurance Company
<br />20702
<br />SAN DIMAS, CA 91773
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: CLE-006795141-06 REVISION NUMBER: 4
<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 />ADDLSUBR
<br />INSD
<br />WAD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYYJ
<br />POLICY EXP
<br />(MM/DDIYYYYJ
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX I OCCUR
<br />Contractual Liability
<br />HDO G72488301
<br />0710112021
<br />07/0112022
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />_DAM7I= RENTED
<br />PREMISES Ea occurrence)
<br />$ 2,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />X
<br />Broad Farm PD
<br />PERSONAL S AOV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY PRO-JECT LOC
<br />OTHER:
<br />GENERALAGGREGATE
<br />$ 5,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$ 5,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY PAUTOS ONLY
<br />ISA H25540918
<br />0710112021
<br />0710112022
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 5,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />XEUG71635290003
<br />0710112021
<br />0710112022
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />DIED I I RETENTION
<br />$
<br />C
<br />A
<br />D
<br />WORKERS COMPENSATION
<br />' AND EMPLOYERSLIABILITY YIN
<br />OFFICERIMEMB REXCLU EDANYPROPRIETORPARTNIERIEy ECUTIVE N
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WLR C67808824 (ADS)
<br />WLR C67808782 (CA,MA,AZ)
<br />SCF C67808861 (WQ
<br />07101/2021
<br />07101I2021
<br />0710112021
<br />0710112022
<br />07/0112022
<br />07/0112022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 2,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 2,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be allachad if more space is required)
<br />THE CITY OF SANTA ANA, ITS OFFICERS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARe ADDITIONAL INSURED (EXCEPT FOR WORKERS COMPENSATION) ONLY AS REQUIRED BY WRITTEN
<br />CONTRACT WITH RESPECT TO THE OPERATIONS OF THE NAMED INSURED. GENERAL LIABILITY AND AUTO LIABILITY COVERAGE EVIDENCED HEREIN IS CONSIDERED PRIMARY AND NOW
<br />CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT, WAIVER OF SUBROGATION IS APPLICABLE WHERE REQUIRED BY WRITTEN CONTRACT.
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ATTN: RISK MANAGEMENT DIVISION
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA, 4TH FLOOR
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />lilak Martagenlenf Diwislmt
<br />%~ \�
<br />REVIEWED&APPROVED BY:
<br />©1988-2016 ACORD C
<br />ACORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD
<br />' '
<br />Risk Management Analyst
<br />
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