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Client#: 675030
<br />GLOBAPAYME
<br />ACORDT. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />1 3/26/2025
<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 />Marsh & McLennan Agency LLC
<br />200 Brookstone Centre Pkwy
<br />CONTACT Allison Peak
<br />NAME:
<br />PHONE 706-324-6671 FAX 706-576-5607
<br />A/C, No, Ext : A/C, No
<br />E-MAIL Allison.Peak@MarshMMA.com
<br />Suite 118
<br />Columbus, GA 31904
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Federal Insurance Company A++XV
<br />20281
<br />INSURED
<br />TSYS Merchant Solutions, LLC
<br />Attention: Devery Gauthier
<br />3550 Lenox Road NE, Suite 3000
<br />Atlanta, GA 30326
<br />INSURER B : ACE American Insurance Company A++XV
<br />22667
<br />INSURER C
<br />INSURER D
<br />INSURER E:
<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 />36048071
<br />04/01/2025
<br />04/01/2026
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES (E. occurrrence)$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER :
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY 1 JECT X LOC
<br />PRODUCTS - COMP/OPAGG
<br />$2,000,000
<br />Gen Agg Cap
<br />$100,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />73614277
<br />04/01/2025
<br />04/01/202
<br />COEaMBINED accident SINGLE LIMIT
<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 />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />F
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />79894591
<br />04/01/2025
<br />04/01/2026
<br />EACH OCCURRENCE
<br />$25 000 000
<br />AGGREGATE
<br />s25,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEDT RETENTION $
<br />$
<br />B
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER /EXCLUD /E ECUTIVE�
<br />(Mandatory in NH)
<br />N/A
<br />71750292
<br />71750293
<br />04/01/2025
<br />04/01/2025
<br />04/01/2026
<br />04/01/202
<br />X 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 />A
<br />Hired Auto
<br />77
<br />04/01/2025
<br />04/01/2026
<br />Actual Cash Value
<br />Physical Damage
<br />1!!
<br />$1,000 Comp Ded.
<br />$1,000 Coll Ded.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />First Named Insured: Global Payments Inc. & It's Subsidiaries
<br />APPROVED
<br />City of Santa Ana City, its officers, employees, agents, volunteers and representatives By Tu Tran Nguyen at4:26 pm, May 14, 2025
<br />(GL) Additional Insured per form: 80-02-2367 Additional Insured Scheduled Person or Organization
<br />�1
<br />(GL) Primary and Noncontributory per form: 80-02-2653 Conditions Other Insurance Primary, Tu Tran Digitally signed
<br />Tu Tran Nguyen
<br />(See Attached Descriptions) Date: 2025.05.14
<br />CERTIFICATE HOLDER CANCELLATION J
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Plaza 4th Floor
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) 1 of 2
<br />#S14888923/M14888474
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