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DATE(MM/DDYYY)
<br /> ACORN° Y
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> 07/01/2024
<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 endorsements .
<br /> PRODUCER CONTACT
<br /> Marsh Risk&Insurance Services NAME:
<br /> 17901 Von Karman Avenue,Suite 1100 A/C PHONE No.Ext: F'C No):
<br /> (949)399-5800;License#0437153 E-MAIL
<br /> Irvine,CA 92614 ADDRESS:
<br /> Attn:NewportBeach.CertRequest@marsh.com/F:212-948-4323 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> CN115158923-01-01-24-25 INSURERA: Crum&Forster Specialty Insurance Co 44520
<br /> INSURED PlaceWorks,Inc INSURER B: Travelers Property Casualty Co.Of America 25674
<br /> 3 MacArthur Place,Suite 1100 INSURER C:
<br /> Santa Ana,CA 92707
<br /> INSURER D
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: LOS-002212046-32 REVISION NUMBER: 12
<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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER
<br /> POLICY EFF POLICY EXP
<br /> LTR MM/DD/YYYY MM DD YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY X X EPK148300 07/01/2024 07/01/2025 EACH OCCURRENCE $ 5,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE 1XI OCCUR PREMISES
<br /> Ea c.."ence $ 100,000
<br /> X BI&PD Ded.$5,000 MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 5,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000
<br /> X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 5,000,000
<br /> OTHER: Contractors Pollution $ 5,000,000
<br /> B AUTOMOBILE LIABILITY X X BA-1N96406A-24-43-G 07/01/2024 07/01/2025 C Ea OMaccBcd.nt)SINGLE LIMIT $ 1,000,000
<br /> ident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTYDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> Comp/Coll Deductibles $ 1,000
<br /> B UMBRELLALIAB X OCCUR EX-6J328756-24-43 07/01/2024 07/01/2025 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION UB-7K728676-24-43-G 07/01/2024 07/01/2025 PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN X STATUTE I ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N❑ N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Errors&Omissions-Claims Made EPK148300 11/11/2024 07/11/2025 Each Claim/Aggregate 5,000,000
<br /> Retro Dates:See 2nd Page
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Operations performed by the named insured for the certificate holder
<br /> City of Santa Ana,its officers,agents,employees,and volunteers are included as additional insured where required by written contract with respect to General and Auto Liability.This insurance is primary and non-
<br /> contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to General Liability.Waiver of subrogation is
<br /> applicable where required by written contract with respect to General and Auto Liability.
<br /> APPROVED
<br /> By Cynthia Mora at 3:00 pm,Dec 04, 2024
<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 /> W&Wa Red & S
<br /> @ 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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