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Ac®� CERTIFICATE OF LIABILITY INSURANCE DATElYYIY)
<br /> 05114120254f2025
<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(ios)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 /> 30 South 17th Street PHONE FAX
<br /> AM o t• " No
<br /> Philadelphia,PA 19103 aDnRl�ss:
<br /> Attn:NBCU.Certrequest@marsh.com Fax 212-948-5143
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> CN101608515-N8CU-GAWUW-24- INSURER A: ACE American Insurance Company 22667
<br /> INSURED NBCUniversal Media,LLC INSURER B: Indemnity Ins Co Of North America 43575
<br /> a fully owned subsidiary of Conrl Corporation INSURER C: ACE Property n _Qa5ualty Ins Co 20699
<br /> 30 Rockefeller Plaza INSURER D: ACE Fire Underwri s.Co. 24702
<br /> NewYork,NY 10112
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CLE-007329709-04 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 I ADDLSUBR. POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDD1YYYY MMIDDrn YY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY XSL G4893044A 12101/2024 12l0112025 EACH OCCURRENCE $ 19,900,000
<br /> CLAIMS-MADE X❑OCCUR DAMAGES( ED
<br /> PREMISES Eaa o occcurrence) $ 19,90Q000
<br /> X SIR:$100,000 MEO EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 19,900,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 60,000,000
<br /> X POLICY JECTPRO-
<br /> [:] LOC PRODUCTS-COMPlOP AGG $ 15,440,044
<br /> OTHER: $
<br /> A AUTDMOBILELIABILITY I5AH11352637 1210112024 12101/2025 COMBiNEDSINGLELIMIT $
<br /> Ea accident 20,000,000
<br /> X ANYAUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY Per accident
<br /> AUTOS ONLY AUTOS B ( ) $
<br /> HIRED NON OWNEDPROPERTYDAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> C X UMBRELLA LAB X OCCUR XEU G27924840 010 1210112024 12/01/2425 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> QED RETENTION S $
<br /> B WORKERS AND EMPLOYERS'LIABILITY ABILITY WLR C72613363(ADS) 12/01/2024 12/01/2025 X STA UTE ER
<br /> A Y t N WLR C72613405 CA,MA 12/0112024 1210112425
<br /> OFFICE IMEMB RIPARTNEREXECUTIVE { ) E.L.EACH ACCIDENT $ 2,000,400
<br /> D OFFICERlMEMBEREXCLUDED? � NIA
<br /> (Mandatory in NHI SCF C7261348A(WI) 12/01/2024 12141I2025 E.L.DISEASE-EA EMPLOYEE $ 2,000,000
<br /> If yes,describe under D $
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 2,000,000
<br /> A Excess Workers Compensation WCU C72613442(WA) 12/01/2024 12101/2025 Ea AodDis EmployeelDis Pdic t 2,000,000
<br /> SIR 5,000,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required)
<br /> RE:City of Santa Ana conducts background screening with NCSI
<br /> City of Santa Ana is included as additional insured(except workers'compensation)where required by written contract with the Named Insured. This insurance is Primary&Non-Contributory with any other
<br /> insurance available to the Certificate Holder. NBCUniversal Media,LLC subsidiaries include,but are not limited to:SportsEngine Inc.dba National Cente€for Safety Initlatives LLC Waiver of subrogation is
<br /> applicable where required by written contract. Digitally signed by
<br /> TuTran Nguyen pat,2QZSOs15 APPROVED
<br /> 09:31:39-07'00' By Tu Tran Nguyen at_9:3'!_aM,_1Nay 15,2025
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attn:Lauren Hirano, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza,M-24, ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA LLC
<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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