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CERTIFICATE LIABILITY
<br />DATE (MMIDDIYYYYt
<br />1212112015
<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(ie's) 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 CONTACT
<br />MARSH USA, INC. _NAME:
<br />PHONE, FFi%
<br />445 SOUTH STREET_(AX. tio Exll ._ _.__..._._._..,._ ..... - ---- A1C NOL
<br />MORRtSTOWN, NJ 07960-6454 E-MAIL
<br />Attn: Morristown.certrequest@marsh.com Fax 212948-0979 ADDRESS:
<br />INSURERtS) AFFORDING COVERAGE NAIL #
<br />123456--GAWUP-.16.17 INSURER A: Arch Insurance Company 11150 - -
<br />INSURED .,..INSURER B NIA NIA
<br />Onex York Holdings Corp.
<br />and its Subsidiaries INSURER c . Aspen Specialty Insurance Company 10717
<br />1 Upper Pond Road - - ----
<br />Building F„ 4th Floor INSURER D:
<br />Parsippany, NJ 07054 INSURER E
<br />INSURER F
<br />COVFRAnFS CFRTIFICATF NUMBER- NYC -007992562-18 RFVISION NtIMRFR-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 IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />. ......., ._.... ADDLSUER-,,...,.,_...,.'.. .. ,...
<br />INSR EXP
<br />MOLIC YFFF MOLICY
<br />TYPE OF INSURANCE POLICY NUMBER YYY LIMITS
<br />LTRInINSD
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />ZAGLB1920000
<br />12/1512015
<br />07101/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />DAMAGE TO RENTED --
<br />--_-
<br />CLAIMS -MADE OCCUR
<br />_ REMISES,jEaacc:urrer?,ce) ........
<br />$ 399,999
<br />MEQ EXP (Any one person)
<br />$ 19,999
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENT. AGGREGATE LIMIT APPLIES PIE=R
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />L.. _
<br />POLICYPRO-
<br />LOC
<br />JEC7..
<br />PRODOG 18 - (OMPIOP AGG
<br />_..-...-.._.._... w_-_ _ ..... ......._
<br />$ 2,040,600
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />__..,_.
<br />COMBINED SINGLE LIMIT
<br />_.LF? dccldenf)
<br />$
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED .... SCHEDULED
<br />-- AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />ff'F20PLR'I`Y I]AMAGE,........
<br />$
<br />_ HIRED AUTOS AUTOS
<br />..41.:..r accident)
<br />-.
<br />UMBRELLA LIAB OCCUR
<br />'... EAC..H, OCCURRENCE
<br />$
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGREGATE
<br />$
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ZAWCI1804400
<br />1211512016
<br />07/01X2017
<br />X I PER GTH::
<br />AND EMPLOYERS' LIABILITY YIN
<br />_.._..,. STATU'T'E m,,,,.ER -
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />E.L EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA A
<br />.—_ _ .___._,.,..,._.___,.-
<br />(Mandatory in NH)
<br />EL DISEASE EA EMPLOYEE
<br />$1,060,600
<br />If yes, describe under
<br />_
<br />Fs 1,000,660
<br />DESCRIPTION OF OPERATIONS below
<br />EL DISEASE POLICY, irArr
<br />C
<br />PROFESSIONAL LIABILITY
<br />LRO03TG16
<br />0613012016
<br />0613012017
<br />LIMIT 10,000,060
<br />RETENTION: $1M (PER CLAIM)
<br />APPLIES TO CLASS ACTION CLAIMS
<br />RETENTION 500,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS d VEHICLES (ACORD 101, 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 WORKERS COMPENSATION AND
<br />PROFESSIONAL LIABILITY) WHERE REQUIRED BY WRITTEN CONTRACT. THIS INSURANCE IS PRIMARY AND NON-CONTRIBUTORY OVER ANY EXISTING INSURANCE AND LIMITED TO LIABILITY
<br />ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED AND WHERE REQUIRED BY WRITTEN CONTRACT WITH REGARD TO GENERAL LIABILITY.
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Finance Department 3 rd Floor THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza M17 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />ManaShi MUkherjee
<br />C7 1988-2014 ACORD CORPORATION. All rights reserved.
<br />C
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Id'1Lre' N'
<br />m�
<br />I Cr,
<br />
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