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A�® CERTIFICATE OF LIABILITY INSURANCE 7OT2
<br /> 5/202DIYYYY)
<br /> 5/2025
<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 rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> MARSH USA,LLC. NAME'
<br /> PHONE FAX
<br /> 1166 AVENUE OF THE AMERICAS (A/C,No Ext: A/C,No
<br /> NEW YORK,NY 10036 E-MAIL
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> CN103822546-VT To-GAWUC-24- INSURERA: Great Northern Insurance Company 20303
<br /> INSURED Veritext,LLC INSURER B: Pacific Employers Insurance Company 22748
<br /> 290 West Mount Pleasant Avenue INSURER C: ACE American Insurance Company 22667
<br /> Livingston,NJ 07039
<br /> INSURER D
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: NYC-012236199-01 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER
<br /> POLICY EFF POLICY EXP
<br /> LTR MM/DDIYYYYI iMMIDDIYYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 3605-66-62 08/01/2024 08/01/2025 EACH OCCURRENCE $ 1,000,000
<br /> RENTEDDAMAGE TO
<br /> CLAIMS-MADE X� OCCUR FIR SES(E..";
<br /> Ea occrre... $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,N
<br /> 000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 7360-98-67(NJ) 08/01/2024 08/01/2025 COMBINED SINGLE LIMIT $ 1,000,000
<br /> Ea accident
<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 /> X AUTOS ONLY AUTOS ONLY Per accident)
<br /> $
<br /> Comp/Coll Deductible $ 1,000
<br /> A X UMBRELLALIAB X OCCUR 7988-74-42 08/01/2024 08/01/2025 EACH OCCURRENCE $ 20,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 20,000,000
<br /> DED X RETENTION$ 10000 $
<br /> B WORKERS COMPENSATION 7174-96-28 (NJ),New Mexico 08/01/2024 08/01/2025 PER oTH-
<br /> AND EMPLOYERS'LIABILITY ( ) X STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE YIN AL,AR,AZ,CA,CO,CT,DC,DE,FL,GA,D,L E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N❑ NIA
<br /> (Mandatory in NH) IN,KS,LA,MA,MD,MI,MN,MO,MT,NC,NV E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> Dyes,describe under D NY,OK,OR,PA,SC,TN,TX UT,VA,W 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Cyber D9821558A 08/01/2024 08/01/2025 Limit(See Acord 101) 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are included as additional insured(except Worker's Compensation)where required by written contract.Waiver of
<br /> subrogation is applicable where required by written contract and subject to policy terms and conditions.
<br /> Digitally signed Tran nNg APPROVED
<br /> Date:2025.04.23
<br /> Nguyen 14:26:23- By Tu Tran Nguyen at 2:25 pm,Apr 23,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attn:Clerk of the City Council THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza(M-30) ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> P.O.Box 1988
<br /> Santa Ana,CA 92702-1988
<br /> AUTHORIZED REPRESENTATIVE
<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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