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Digit. fly Big—d by Francine R.
<br />Francine R. Villareal villa
<br />Date:Page]a t:SC& 020'
<br />.� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(M0
<br />12/1/2021/2021
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Willis Towers Watson Northeast, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />CONTACT Willis Towers Watson Certificate Center
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-888-467-2378
<br />AIC No Ext : AIC, No):
<br />E-MAIL certificates@willis.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />Nashville, TN 372305191 USA
<br />INSURER A: ACE American Insurance Company
<br />22667
<br />INSURED
<br />Pitney Bowes Inc.
<br />3001 Sumner Street
<br />INSURER B : Commerce & Industry Insurance Company
<br />19410
<br />INSURERC: Indemnity Insurance Company of North Ameri
<br />43575
<br />INSURER D : ACE Fire Underwriters Insurance Company
<br />20702
<br />Stamford, CT 06926
<br />INSURERE: National Fire & Marine Insurance Company
<br />20079
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W23052463 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 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />MM DDPOLICY
<br />IYYYYI
<br />iMM/DDfYYYYI
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE �DAMAGE
<br />OCCUR
<br />PREMESOEa occurrDence
<br />S
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />A
<br />y
<br />HDO G72491075
<br />07/01/2021
<br />07/01/2022
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY ❑ PRO JECT ❑ LOC
<br />X
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />ISA H25550511
<br />07/01/2021
<br />07/01/2022
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />66323214
<br />07/01/2021
<br />07/01/2022
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? No
<br />(Mandatory in NH)
<br />NIA
<br />WLR C67814630
<br />07/O1/2021
<br />07/O1/2022
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 2,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />2,000,000
<br />$
<br />A
<br />Workers Compensation and
<br />WLR C67814678
<br />07/01/2021
<br />07/01/2022
<br />E.L. Each Accident
<br />$2,000,000
<br />Employers' Liability
<br />E.L. Disease -Ea Emp.
<br />$2,000,000
<br />Per Statute
<br />E.L. Disease Policy
<br />$2,000,000
<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 06/29/2021 WITH ID: W21417247.
<br />SEE ATTACHED
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL
<br />BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Risk Management Division
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />PW ".iF
<br />IZisil:ManagmentDMsllm
<br />Santa Ana, CA 92702�A°
<br />x
<br />REVIEWED &APPROVED SY:
<br />© 1988-2016 ACORD C
<br />I,?`
<br />ACORD 25 (2016/03)
<br />The ACORD name and logo are registered marks of ACORD
<br />_ffmym
<br />Risk MPanagement Analyst
<br />SR ID: 21927888 BATCH: 2336113
<br />
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