|
Page 1 of 2
<br /> ACORD DATE(MMMDIYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 03/18/2026
<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 ondorsement(s).
<br /> PRODUCER CONTACT NAME: Willis Towers Watson Certificate Center
<br /> Willis Towers Watson Northeast, Inc. PHONN Ex 1-$77-945-7378 C No: 1-898-467-2378
<br /> c/o 26 Century Blvd EMAIL
<br /> P.O. Box 305191 ADDRE S: Certificates @will is.com
<br /> Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURERA: XL Insurance America Inc 24554
<br /> INSURED INSURERB: Travelers Property Casualty Company of Ame 25674
<br /> Fieldturf USA, Inc.
<br /> c/o Sports Division INSURERC: Standard Fire Insurance Company 19070
<br /> Tarkett Inc. INSURER D: Berkley Assurance Company 39462
<br /> 7445 Cote-de-Liesse Road, Suite 200
<br /> INSURER E:
<br /> Montreal, QC H4T 1G2 CAN
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:W44772348 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 INDICATED.
<br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF
<br /> SUCH POLICIES. 'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
<br /> HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY BFF POLICY EXP LIMITS
<br /> LTR POLICYNUMBER MMIDDIYYYY MMIDDIYYYY
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMACLAIMS-MADE � OCCUR PREMISES
<br /> Eaoc 500,000
<br /> PREMISES Ea occurrence $
<br /> A MED EXP(Any one person) $ 10,000
<br /> Y Y US0001C327LI25A 05/01/2025 05/01/2026
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'LAGGREGATELIMITAPPLIESPER; GENERALAGGREGATE $ 2,000,000
<br /> POLICY X JEC7 PRO- LOC PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMHINED SINGLE LIM T
<br /> Ea accident $ S,OOD,D00
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED Y Y TC2JCAP-823K312A-TIL-25 05/01/2025 05/01/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NCN-OWNED PROPHRTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> X UMBRELLALIAa X OCCUR EACH OCCURRENCE $ 5,000,D00
<br /> A EXCESSLUI6 CLAIMS-MADE AGGREGATE $Y Y USOOOI0615LI25A 05/01/2025 05/01/2026 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> B ANYPROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEMBEREXCLUL Na NIA Y UB-8P793534-25-51-K 05/01/2025 05/01/2026
<br /> (Mandatory inNHI E.L.DISEASE-FA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Workers Compensation & Y UB-SP760619-25-51-R 05/01/2025 05/O1/2026 E.L. Each Accident $1,000,000
<br /> Employer's Liability E.L, Disease--Pol Latt $1,000,000
<br /> Per Statute E.L. Disease-Each $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> This Voids and Replaces Previously Issued Certificate Dated 02/13/2026 WITH ID: W43963762,
<br /> Project: City of Santa Ana (CA) - Santa Anita Park Soccer - 00004178
<br /> Agreement No. A-2023-018
<br /> SEE ATTACHED �g�y
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> i3y Tu Traff-Nii yen at?let a ,ar 0q
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Public Works Agency
<br /> AUTHORIZED REPRESENTATIVE
<br /> 20 Civic Center Plaza
<br /> PO Pox 1988
<br /> Santa Ana, CA 92702
<br /> ©1988-2025 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2025//12) The ACORD namo and logo are registered marks of ACORD
<br /> sit To: 29589925 —C!H: 4369005
<br />
|