|
/+ CERTIFICATE OF LIABILITY INSURANCE
<br />DATE JMM(DD/YYYY)
<br />9elo7maa
<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(les) 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 />MARSH USA INC
<br />CONTACI
<br />NAME`
<br />PAtG.
<br />1050 CONNECTICUT AVENUE SUITE 700
<br />N2.EXi1;___—.LA1X
<br />WASHINGTON, DC 20038 5386
<br />-MAIL
<br />ADORES,S:....—__._�._..._.._�....,_
<br />INSUREIRIS1 AFFORD No COVERAGE NAICM
<br />GN101976702-MULTI-EO41-18-19
<br />IN IJRERA: O:eat Ne?NIONAI SUrance Cemeany 20303
<br />_
<br />INS
<br />ICMA RETIREMENT CORP,
<br />INSURER 6: NIA N/A
<br />INSURERS: Pacific Indemnity Insurance Company__20346 _ -
<br />ATTN: D'JUANA THOMAS
<br />777 NORTH CAPITOL ST„ HE
<br />INSURERtl Federal Compa,,!,IN._ 20281
<br />WASHINGTON, OC 20002
<br />,IpsylencD
<br />INSURERS Travelers Casually Id Surety 31194
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: CLE-006041484-38 REVISION NUMBER: 5
<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
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN9R_. ..___�_.... _ .....—.,..._ ....._... ADOLs BR __.._..._._...� ...... POLICY EFF..... P6LICYEXF"
<br />_........_..._. ,_,.._,.._--
<br />._ .__... _....._
<br />L TYPE OF INSURANCE POLICYNUMBER IMMIDDIYYY (MMIDDNYYYI
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />360449„95 08/0112018 0810112019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE IE OCCUR
<br />'UA AG, E EG.—_—.._...—_
<br />r`RE ISE „ Ee.MFe
<br />_.._
<br />$ 1,000,000
<br />_— —
<br />X CONTRACTUAL OV INCL—^-_....
<br />MLU EXF A one �arsvn
<br />t ro
<br />.$
<br />PERSONAL&ADV INJURY_
<br />$ 00,000
<br />1,010000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X JECT X LOC
<br />PRODUCTS-COMP/OP AGO
<br />$ 2,000,000
<br />OTHER
<br />$
<br />AUTOMOBILE LIABILITY
<br />_(Ea
<br />COMBINED SINGLELIMIT
<br />acadenl) _
<br />$
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY(PnI.Aodenp
<br />7
<br />HIRED NON -OWNED
<br />PROPERTY DAMAGE
<br />„
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />y_PW-ddan�__,,,
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LIAB _CLAIMS -MADE
<br />AGGREGATE
<br />$
<br />CEO RETENTION$
<br />$
<br />C WORKERS COMPENSATION
<br />08101/2018 ublujl2ulB
<br />X P R I OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRI ETOWPARTN ERIEXECIJTIVE
<br />EL EACH ACCIDENT
<br />$ 1000000
<br />OFFICERIMEMBrI EXCLUDED? F7N
<br />NIA
<br />— "'-'
<br />---
<br />(Mandatory In NH)
<br />EL DISEASE -EA EMPLOYEE $
<br />10000UU
<br />Iliac, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />,..-......—
<br />E,L. DISEASE -POLICY LIMIT
<br />__— . ..
<br />$ 1,000,000
<br />D BANKERS PROF. HAS
<br />8211„0261 06130I2018 06/30120f9
<br />$7,500,000 ek,$i2,500,000
<br />E SIR:$1,000,000
<br />106758967 06130/2018 06/3012019
<br />$5,000,000 ice $12,500,000
<br />DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD101, Additional Networks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />CIT YOF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ATTN: EXECUTIVE DIRECTOR OF PERSONNEL SVS
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA M-34
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />SANTA ANA, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee
<br />©1g66-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
|