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A-2017-265-24-01 ACi DI CERTIFICATE OF LIABILITY INSURANCE OATE,2020 YYY) e6z21zo29 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlfteate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Marsh Risk $ Insurance Services 17901 Von Kaman Avenue, Suite 1100 (949) 390,5800, License #0437153 Irvine. CA 92614 CONTACT NAME: _ __ PHONE FAX -- c No EMAIL ADDRESS, - INSUFf AFFORDING COVERAGE NAICa ADo: NewponBeach GarRequesthlmar5h coi 2129464323 INSURER A: Crum B Forster Specialty Insurance Cc 44520 CN115158923-01-01-20-21 INSURED PlaceWorks, Inc_ INSURER B: Travelers Indemnity Company Of ConneCllCul 2515822 INSURER C : Travelers property Casualty Company Of America 25874 3 MacArthur Place, Suite 1100 Santa Ana. CA 92707 INSURER O: _ INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: L0S-W2212046-24 REVISION NUMBER' 9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOIL SUerirl POLICY NUMBER POLICY EFF MMR)O POLICY E%P MMIDDIYYYY - DMITS A X COMMERCIAL GENERAL LIABILITY CLAIMSMaOE OCCUR X X EPK131438 07:012020 07I1 Q021 EACH OCCURRENCE I S 5.C40,000 PREMISES Ea ocwrrence S 50000 PD Ded. $5,000 MED EXP (Any ore person) S 5.000 PERSONAL S ADV INJURY S 5000000 GENERAL AGGREGATE CIS S,000 OOO -Ell AGGREGATE LIMIT APPLIES PER POLICY JEa �LOC PRODUCTS - COMPIOP AGG S 5.000,000 Contractors PDllulion OTHER S 5.000.000 AUTOMOBILE LIABILITY X X ISAiN96408A20C.AG '07I112020 070, 2021 COMBINED PIN LE LIMIT (Ea aaldeo) i S 1.000. CM -'. �.wW BODILY INJURY (Per person S OWNED SCHEDULED U TOS ONLY AUTOS BODILY INJURY (Par acadenn S HIRED NON OWNED UTOS ONLY _ AUTOS ONLY PROPERTY DAMAGE IF. aC[leenn S Comp1C011 Deductibles S 1 000 UMBRELLA LIAR % OCCUR _ E%613287562014 07:I12020 07,01021 EACH OCCURRENCE I S 4,000.000 EXCESS LIAR �CVuMS-MADE _ �— AGGREGATE Is 4,000.nAO S GE- RETENTIONS WORKERS COMPENSATION 'ANDEMPLOYERS'UABIUTY YIN AN YPROPRIETORIPARTNEH EXECUTIVE CFFICERIMEMBEREXCLUDED� F NIA UB7K7286762014G 071)V2020 T 1 1 g PER DTH- TATUTE ER EL EACH ACCIDENT S 1,000.1700 ' E L DISEASE EA EMPLOYE S 1,000 CIO (Mandatory In NH) If )es descnibe under DESCRIPTION OF OPERATIONS mi. "EL DISEASE - POLICY LIMIT -' ---- S 1,000DW A Enors 8 Onnesions Clams Made EPKI31436 07,0112020 07,0112021 Each ClaimlAggregate 5,000.000 Reim Dales See 2nd Page I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarks Schedule, my lea anachad if more space is resulted) Re Operations performed by the named Insured for the certificate holder Gill of Santa Ana its officers. agents, employees, and volunteers are included as additional Insured where moored by written contract with respell to Genera and Auto Liability This insurance s primary and non. contributory over any existing :insurance and limited to habdity arising out of the operatwns of the named insured and where required by written contract wlh respect to General Lability Waver of subrogation is appitcable where required by written contract with respect to General and Auto L abibry City of Santa Ana Risk Management Dinsicn 20 Chi Center Plaza, 4th H Santa Ana, CA 92701 ffi2 7 60 FI ANCINE R. IL REAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE of Marsh Risk a insurance Services Rosalynda Martinez Vt. ©1988-2016 ACORD reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD