|
Client#: 688055
<br />Francine R. Digitally signed by Francine R.
<br />Villareal
<br />ADMINSUREI Villareal Date:2021.08.24083323 OT00'
<br />ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE
<br />TE (MM/DD/YYYY)
<br />DA8/23/2021
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Rocio Gutierrez
<br />NAME:
<br />Marsh & McLennan Agency LLC
<br />aHON o, 949 900-1780 FAX
<br />Marsh & McLennan Ins. Agency LLC
<br />El , No):
<br />E-MAIL g ADDRESS: rocio. utierrez marshmma.com
<br />1 Polaris Way #300
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />Aliso Viejo, CA 92656
<br />INSURER A: Sentinel Insurance Company Ltd
<br />11000
<br />INSURED
<br />INSURER B : T-in City Fire Insurance Company
<br />29459
<br />AdminSure, Inc.
<br />Evanston Insurance Company
<br />INSURER C : p Y
<br />35378
<br />3380 Shelby Street
<br />United States Fire Insurance Company
<br />INSURER D : p Y
<br />21113
<br />Ontario, CA 91764
<br />Underwriters at Lloyds
<br />INSURER E : Y
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />72SBABD7973
<br />1/01/2021
<br />01101/2022
<br />EACHOCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE L* OCCUR
<br />PREMISESOEa oceu ante
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />$2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />POLICYFx] JECOT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />72SBABD7973
<br />1/01/2021
<br />01/01/202
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />2e e 000 000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />72SBABD7973
<br />1/01/2021
<br />01/0112022
<br />EACH OCCURRENCE
<br />$4 00U 000
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? [N]
<br />(Mandatory in NH)
<br />N / A
<br />72WECNG7400
<br />01/01/2021
<br />01/01/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />C
<br />Professional Liab
<br />MKLV3PE0001615
<br />10/19/2020
<br />01/01/2022
<br />$5,000,000 Claim/Agg
<br />D
<br />Crime (401K)
<br />6260378562
<br />10/13/2020
<br />01/01/2022
<br />$2,000,000/Ded varies
<br />E
<br />I Cyber-w-3rdParty
<br />ESJ0419616911
<br />07/01/2020
<br />01/01/2022
<br />$2,000,000theftfraud ry
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City, and their respective officers, agents and employees are included as additional insured as
<br />respects to General Liability per attached endorsements. Primary and Non -Contributory Wording applies per
<br />attached endorsement.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S8608782/M8400688
<br />�oRaN RiskManagmentDMSian
<br />REVIEWED & APPRCYVED BY. -
<br />Risk Management Analyst
<br />
|