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n� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDNYYY)
<br />09/04/2019
<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 ON T
<br />Marsh USA Inc.
<br />1717 Arch Street _f HONE FAIC o
<br />Philadelphia, PA 19103-2797 E-MAIL
<br />Attn: NBCU.Certrequest@marsh.com Fax 212-948-5143 ADORE s`
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />298523-NBCU-CAS: 18-19
<br />INSURER : ACE American Insurance Company
<br />22667
<br />INSURED
<br />NBCUniversal Media, LLC
<br />INSURER B : Indemni Ins Co Of North America
<br />43575
<br />a fully owned subsidiary of Comcasl Corporation
<br />suRER c : AC.E.Properly And Casualty In Co
<br />20699
<br />30 Rockefeller Plaza
<br />INSURER D : ACE Fire Underwriters Ins. Co-
<br />20702
<br />New York, NY 10112
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:
<br />CLE-006474231-03 REVISION NUMBER: 7
<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 />MSR AnoTYPE OF INSURANCE L S BR POLICY NUMBER MMIDPOLICDfYYYY MMIDY ERF C LTR DIYYYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />XSLG71209313
<br />12/01/2018
<br />12/01/2019
<br />EACH OCCURRENCE
<br />$ 4,900,000
<br />CLAIMS -MADE M OCCUR
<br />$ 4,900,000
<br />DAMAGE
<br />PREMISES lEMELTrencel
<br />X
<br />MED EXP (Any one arson)
<br />$ 10,000
<br />SIR: $100,000
<br />PERSONAL & ADV INJURY
<br />$ 4,900,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 25,000,000
<br />X POLICY u PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$ 6,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />ISAH25275354
<br />12/01/2018
<br />12/01/2019
<br />COMEItNFD LE��dantsl u.
<br />$ 10,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAM GE
<br />_[P„Br ardent
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />L
<br />$
<br />G
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />X00 G27924840 004
<br />12/01/2018
<br />12/01/2019
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />A
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBEREXCLUDED? F7N .
<br />(Mandatory in NH)
<br />NIA
<br />WLRC65440398 (AO)
<br />WLRC6544043A (CA, MA)
<br />SCFC65440519 (WI )
<br />12/01/2018
<br />12/01/2018
<br />12/01/2019
<br />12I01I2019
<br />X ATH-
<br />STUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 2,000,000
<br />[ElL. DISEASE - EA EMPLOYE.
<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 />A
<br />Excess Workers Compensation
<br />WCUC65440477 (WA)
<br />12/01/2018
<br />12/01/2019
<br />Ea Acc/Dis Employee/Dis Policl
<br />2,000,000
<br />SIR
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are named as additional insured in regards to General Liability as per attached Additional Insured
<br />Endorsement. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.
<br />�Y�j 4-2 1� v f,
<br />CFRTIFICATF Hf)I nFR CANCFLLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />O 1 Q
<br />201 9
<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, 4th floor
<br />r 1 t7
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />111,
<br />A CIA M. LAMBERT
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee.aoo►.:L. c
<br />(0 1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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