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ACC>RlDlili CERTIFICATE OF LIABILITY INSURANCE r
<br /> ATE(MMIDDIYYYY)
<br /> 07/1112025
<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 endorsements.
<br /> PRODUCER CONTA T
<br /> Marsh Risk&Insurance Services NAME:
<br /> 17901 Von Karman Avenue,Suite 1100 OCON o aIc No):
<br /> (949)399-5800;License 0437153 E-MAIL
<br /> Irvine,CA 92614ADDRESS:
<br /> Attn:NewportBeach.CedRequest@marsh,com/F:212-948-4323 INSURERS AFFORDING COVERAGE NAIL 0
<br /> CN115158923.01-01-25-26 INSURER A: Starr Surplus Lines Insurance Company 13604
<br /> INSURED PlaceWorks,Inc INSURER B: TravelcLLPmpefty Casually Co.OfAmerica 25674
<br /> 3 MacArthur Place,Suite 1100 INSURER C: Falcon Insurame Group
<br /> Santa Ana,CA 92707 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 /> ICY EXP
<br /> LTR SU TYPE OF INSURANCE JHM n POLICY NUMBER MM1DDPOLICY EFF MMI�ONYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY y y 1000068067251 07/15/2025 07101/2026 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE ILI OCCUR DAMAGE ED
<br /> PREMISES Ea occurrence $ 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: GENERALAGGREGATE $ 2,000,000
<br /> X POLICY❑JECT LOU PRODUCTS-COMPIOPAGG $ 1,000,000
<br /> OTHER: Contractors Pollution $ 5,000,000
<br /> B AUTOMOBILE LIABILITY y y BA-lN96406A-25-43-G 07/0112025 07/01/2026 CEOMaBBIIIaEeDISINGLE LIMIT $ 1,000,000
<br /> AINY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per eccldenl) $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per a.Iden l $
<br /> X
<br /> Com !Coll Deductibles $ 1,000
<br /> B UMBRELLALIAR X OCCUR EX-6J328756-2543 07/01/2025 07/01/2026 EACHOCCURRENCE $ 4,000,000
<br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> DED I I RETENTION$ $
<br /> B WORKERS COMPENSATION UB-7K728676-25-43-G 07/01/2025 07ATJ2026 X STATUTE ERH
<br /> AND EMPLOYERS'LIABILITY Y I N
<br /> ANYPROPRIETORIPARTNERIEXECUTiVE E.L.EACH ACCIDENT $ 11000,000
<br /> OFFICERIMEMBEREXCLUDED? N NIA
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C Errors&Omissions-Claims Made FRS-H-P-PL-00013383-01 0711512025 07/01/2026 Each Claim/Aggregate 5,000,000
<br /> Retro Dates:See 2nd Page
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached IFmore 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 insured and where required by written contract with respect to General Liability,Waiver ofsubrogatien is
<br /> applicable where required by written contract with respect to General and Auto Liability,
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION By To Tran'lY rryen ats:18 am— 8 2-.
<br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 20 Civic Center Plaza,4th Floor ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana,CA 92701
<br /> AUTHORIZED REPRESENTATIVE e yy
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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