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<br /> A`oRo° CERTIFICATE OF LIABILITY INSURANCE 7OT7
<br /> 1/202DIYYYY)
<br /> 1/20 2 5
<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 CONTACT
<br /> Marsh Risk&Insurance Services NAME:
<br /> PHONE FAX
<br /> 17901 Von Karman Avenue,Suite 1100 (A/C,No Ext: A/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 /> CN115158923-01-01-25-26 INSURERA: Starr Surplus Lines Insurance Com an 13604
<br /> INSURED PlaceWorks,Inc INSURER B: Travelers Property Casualty Co.Of America 25674
<br /> 3 MacArthur Place,Suite 1100 INSURER C: Falcon Insurance Group
<br /> Santa Ana,CA 92707
<br /> INSURER D
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: LOS-002212046-35 REVISION NUMBER: 13
<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/DDIYYYYI iMMIDDIYYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY y y 1000068067251 07/15/2025 07/01/2026 EACH OCCURRENCE $ 1,000,000
<br /> RENTEDDAMAGE TO
<br /> CLAIMS-MADE X� OCCUR FIR SES Ea occurre... $ 50,000
<br /> X BI&PD Ded.$5,000 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,N
<br /> 000
<br /> OTHER: Contractors Pollution $ 5,000,000
<br /> B AUTOMOBILE LIABILITY y y BA-1N96406A-25-43-G 07/01/2025 07/01/2026 COMBINED Ea cidendenINGLELIMIT
<br /> tS $ 1,000,000
<br /> ac
<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-6J328756-25-43 07/01/2025 07/01/2026 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION UB-7K728676-25-43-G 07/01/2025 07/01/2026 PER OTH-
<br /> AND EMPLOYERS'LIABILITY X STATUTE ER
<br /> Y/N
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N❑ NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Errors&Omissions-Claims Made FRS-H-P-PL-00013383-01 07/15/2025 07/01/2026 Each Claim/Aggregate 5,000,000
<br /> Retro Dates:See 2nd Page
<br /> DESCRIPTION OF OPERATIONS I 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 i nsured 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 /> TuTran TuTaI,1,,,,
<br /> Nguyen 1Date-30-0 00' APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 10:19 am,Aug 12,2025
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Planning and Building Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> %W4�c¢(¢ &�r ctnar2ce $'enaiced
<br /> @ 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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