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Francine R.
<br />Villareal
<br />� 1 CAUMUKU-till
<br />SMCGREGOR
<br />A� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMloovyvr)
<br />I
<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 endorsements .
<br />PRODUCER
<br />NQMEACT Sue Hong
<br />SCS Agency, Inc.
<br />1981 Marcus Avenue Suite 125
<br />Lake Success, NY 11042
<br />PHONE
<br />No, Est): (516 726.2'6 FAX
<br />) uc, No):(516) 829-5857
<br />X-ErpAgless.5hong@scsaLcom
<br />INSURERIS1 AFFORDING COVERAGE
<br />NAIC e
<br />INSURER A: Hartford Fire Insurance Co.
<br />19682
<br />INSURED The Cadmus Group LLC Obsidian Analysis LLC Cadmus
<br />INSURER B:Trumbull Insurance Co
<br />27120
<br />INSURER C: Hartford Casualty Ins Co.
<br />29424
<br />Holding Company Inc Meister Consultants Group Inc
<br />INSURER D: Federal Insurance Co.
<br />20281
<br />Cadmus lnterntional Inc
<br />Sth Ave Ste 451
<br />Waltham,
<br />Waltham, MA 02457
<br />lNsuRE 1 E:Indian Harbor Insurance Company
<br />36940
<br />NSURERF:
<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 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 />ILTR NSR
<br />TYPE OF INSURANCE
<br />ADDLSURR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPIRM
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CIAIMS-MADE [X] OCCUR
<br />Contractural Liab
<br />X
<br />12UUNZK9897
<br />10/31/2020
<br />10131/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO ENTIERD
<br />PREMISES Ma
<br />300,000
<br />X
<br />X
<br />MED UP (Any one arson
<br />10,000
<br />Contractors Poll.
<br />PERSONALS ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY dEOQT 1-1LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS-COMPIOP AGG
<br />$ 2,000,000
<br />EMPLOYEE BENEFI
<br />1,non nn0
<br />OTHER:
<br />B
<br />AUTOMOBILELIABILTY
<br />COMBINED SINGLE LIMIT
<br />accidem
<br />$ l(Ea ggg ggg
<br />BODILY INJURY Per person)$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />12UENBHO271
<br />10131/2020
<br />10/3112021
<br />BODILY INJURY Per accident
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />OPERTY AMAGE
<br />Peraccitlent
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />10,000,000
<br />AGGREGATE
<br />10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />12RHUZK9098
<br />10/3112020
<br />10131/2021
<br />DED I X I RETENTION$ 10,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ ARTNERJEXECUTIVE Y
<br />FCERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yyes. describe under
<br />DESCRIP ION OF OPERATIONS below
<br />NIA
<br />X
<br />12WBGH1066
<br />10131/2020
<br />10131/2021
<br />X PER OTH-
<br />E
<br />E.L. EACH ACCIDENT
<br />1,000,00 0
<br />E.L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />E.L. DISEASE-POUCV LIMIT
<br />1,000,000
<br />D
<br />Crime (Includes Burg
<br />81324354
<br />10131/2020
<br />10/31/2021
<br />Limit
<br />1,000,000
<br />E
<br />Professional Errors
<br />PECO04861704
<br />10131/2020
<br />10/31/2021
<br />Limit
<br />6,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to General and Auto Liability per the attached
<br />endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to Workers' Compensation. 30 Days
<br />Notice of Cancellation with 10 Days Notice for Non -Payment of Premium.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />A. "MoormarttDMafan
<br />e REVIEWED 6 APPROVED BY:
<br />ACORD 25 2016103 ACORD
<br />ACORD 4 " f P' V l
<br />( ) 07988�:, RHk
<br />The ACORD name and logo are registered marks of ACORD Management Analyst
<br />
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