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edly <br />Francine R. Villareal Ylmlmeial signed byFrancirre P. <br />Date'. 2021.06DI 1213s1 LTop' <br />ACOR" CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDD)Y'/YY) <br />1 <br />Ill.i <br />05/28/2021 <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(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 />CONTACT Jeanne Vezina <br />NAME: <br />AssuredPartners Northeast. LLC. <br />"ONE Eae: (914) 761-9000 F No: (914) 761-3749 <br />123 Main Street <br />E' AIL eanne.vezina assured artners.com <br />ADDRESS: I @ p <br />14th Floor <br />INSURERS) AFFORDING COVERAGE <br />NAIC 9 <br />INSURER A: Charter Oak Fire Insurance CD <br />25615 <br />White Plains NY 10601 <br />INSURED <br />INSURER B: The Travelers Indemnity Co. <br />25658 <br />Keenan &Associates <br />INSURER C : Travelers Property Casualty Company of America <br />25674 <br />c/o The AssuredPartners Group, LP <br />INSURER o: Federal Insurance Co. <br />20281 <br />200 Colonial Center Parkway <br />INSURER E: Ace American Ins. Co. <br />37540 <br />Lake Mary FL 32746 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: CLZU1113152381 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 OFINSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDNM <br />POL YEXP <br />MMIDDIYYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />EACH OCCURRENCE <br />S 1,000,000 <br />PREMISES Ea occurrence <br />g 1.000,000 <br />MEDEXP(MyOneperson) <br />S 10,000 <br />PERSONAL B AOV INJURY <br />S 1.000,000 <br />A <br />Y <br />Y <br />6301C226998 <br />10/01/2020 <br />10/01/2021 <br />GENL <br />X <br />AGGREGATE LIMITAPPLIES PER: <br />POLICY JECOT LOG <br />GENERALAGGREGATE <br />S 10,000,000 <br />PRODUCTS -COMPIOPAGG <br />$ 2.000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />S 1,000,000 <br />X <br />BODILY INJURY(Per person) <br />$ <br />ANY AUTO <br />g <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BA61,1912905 <br />10/01/2020 <br />10/01/2021 <br />BODILY INJURY (Per accident) <br />S <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Perawident <br />S <br />S <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACHOCCURRENCE <br />$ 25,000,000 <br />C <br />EXCESS LIAB <br />CLAIMS -MADE <br />CUP9J434350 <br />10/01/2020 <br />10/01/2021 <br />AGGREGATE <br />S 25,000,000 <br />DIED <br />I I RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY <br />OFFIOEMMEBPROPRIET�R EXCLUDED TNEWEXECUrIVE <br />(Mandatory In NH) <br />If yes. DESCRIPTION <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />UB-9P291231-20-14-E <br />10/01/2020 <br />10101/202, <br />PER OTH- <br />STATUTE Eft <br />E.L. EACH ACCIDENT <br />$ 1.000.000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1.000,000 <br />E.L. DISEASE-POLICYLIMIT <br />$ 1,000,000 <br />EMPLOYEE THEFT <br />D <br />8225-9951 <br />10/01/2020 <br />10/01/2021 <br />$10.000,000 LIMIT <br />$200,000 DED. <br />DESCRIPTION OF OPERATIONS / LOCATIONS )VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Insurer E: Cyber Liability, Policy #D94933262, 11/6/20-11/6/21. $10,000,000 Limit, $250,000 Deductible. <br />Re: City of Santa Ana Employee Benefits Consulting Services Agreement 71112021-7/30/2022. <br />The City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if required <br />by written contract with respects to General Liability. A waiver of subrogation applies with respects to General Liability. 30 Day Notice of Cancellation <br />applies. <br />City of Santa Ana, Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />WdrMawBrrncMDiWlpn <br />RENAEwED & APPR��O�JV/�ED BY. <br />c <br />Risk Management Analyst <br />