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Ac ?a® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE iMm1Domtiv)
<br />0711112016
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />MARSH USA, INC.
<br />445 SOUTH STREET
<br />CONTACT
<br />NAME:
<br />PHONEExt) FAC No:
<br />Hh"Ll
<br />ADDRESS,
<br />MORRISTOWN, NJ 07960-6454
<br />Attn: Morristown cel request@marsh.com Fax 212-940-0979
<br />X
<br />INSURERS AFFORDING COVERAGE NAIC 0
<br />INSURER A: Zurich American Insurance Company 16535
<br />123456--GAWUP-15.16
<br />INSURED
<br />a It n York Holdings Corp,
<br />and Its Subsidiaries
<br />INSURER B : NIA N/A
<br />INSURER c :Aspen Specialty Insurance Company 10717
<br />1 Upper Pond Road
<br />Building F, 4th Floor
<br />INSURER D
<br />Parsippany, NJ 07054
<br />INSURER E:
<br />INSURER F:
<br />MED EXP (Any one person) $ 5,000
<br />COVERAGES CERTIFICATE NUMBER: NYC -007992582-13 REVISION NUMBER:28
<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 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />/NSR
<br />R
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIOOYIYYYPV
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />CPO 5820234-02
<br />12/15/2015
<br />12/15/2016
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE M OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $ 1,000,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GEH'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY ❑ PRO -
<br />I LOC
<br />PRODUCTS-COMP/OP AGG $ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />Eo aocid.rt
<br />BODILY INJURY (Per person) $
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE IS
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOWPARTNEWEXECUTIVE Y
<br />OFFICER/MEMBER EXCLUDED? FITI
<br />(Mandatory In NH)
<br />NIA
<br />WC 5820235-02
<br />12/15/2015
<br />12/15/2016
<br />X STATUTE ORH
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />IIdescribe under
<br />RIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />C
<br />PROFESSIONAL LIABILITY
<br />LRO03TG16
<br />06116/2016
<br />06/1612017
<br />LIMIT 10,000,000
<br />RETENTION', $1M(PER CLAIM)
<br />APPLIES TO CLASS ACTION CLAIMS
<br />RETENTION 500,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD IDI, Additional Remarks Schedule, may be attached If more space Is required)
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED (EXCEPT
<br />WORKERS COMPENSATION AND PROFESSIONAL LIABILITY) WHERE REQUIRED BY WRITTEN CONTRACT, 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
<br />REQUIRED BY WRITTEN CONTRACT WITH REGARD TO GENERAL LIABILITY.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Finance Department, 3 rd Floor
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza M17
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashl Mukherjee
<br />ACORD 25 (2014/01)
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />RIiVT Af& 69'
<br />GA. A
<br />49
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