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<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
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<br />04/18/2022
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<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
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<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.
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<br />27;42;15!.18(11(
<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 />CONTACT
<br />PRODUCER Jeanne Vezina
<br />NAME:
<br />FAX
<br />PHONE
<br />AssuredPartners Northeast, LLC.(914) 761-9000(914) 761-3749
<br />(A/C, No):
<br />(A/C, No, Ext):
<br />E-MAIL
<br />445 Hamilton Avenuejeanne.vezina@assuredpartners.com
<br />ADDRESS:
<br />10th Floor
<br />INSURER(S) AFFORDING COVERAGENAIC #
<br />White PlainsNY10601Charter Oak Fire Insurance Co25615
<br />INSURER A :
<br />INSURED The Travelers Indemnity Co.25658
<br />INSURER B :
<br />Keenan & AssociatesKeenan & AssociatesTravelers Property Casualty Company of America25674
<br />INSURER C :
<br />c/o The AssuredPartners Group, LPFederal Insurance Co.20281
<br />INSURER D :
<br />200 Colonial Center ParkwayACE American Insurance Company22667
<br />INSURER E :
<br />Lake MaryFL32746
<br />INSURER F :
<br />CL2111881212
<br />COVERAGESCERTIFICATE 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 />ADDLSUBR
<br />INSRPOLICY EFFPOLICY EXP
<br />TYPE OF INSURANCELIMITS
<br />POLICY NUMBER
<br />LTR(MM/DD/YYYY)(MM/DD/YYYY)
<br />INSDWVD
<br />COMMERCIAL GENERAL LIABILITYCOMMERCIAL GENERAL LIABILITY 1,000,0001,000,000
<br />EACH OCCURRENCE$
<br />DAMAGE TO RENTED
<br />1,000,000
<br />CLAIMS-MADEOCCUROCCUR$
<br />PREMISES (Ea occurrence)
<br />10,000
<br />MED EXP (Any one person)$
<br />AYY6301C22699810/01/202110/01/202210/01/20221,000,000
<br />PERSONAL & ADV INJURY$
<br />10,000,00010,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$
<br />PRO-
<br />2,000,000
<br />POLICYLOCPRODUCTS - COMP/OP AGG$
<br />JECT
<br />$
<br />OTHER:
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITYAUTOMOBILE LIABILITY 1,000,0001,000,000
<br />$
<br />(Ea accident)
<br />ANY AUTOANY AUTOBODILY INJURY (Per person)$
<br />OWNEDSCHEDULED
<br />BBA6N91290510/01/202110/01/202210/01/2022
<br />BODILY INJURY (Per accident)$
<br />AUTOS ONLYAUTOS
<br />HIREDNON-OWNEDPROPERTY DAMAGE
<br />$
<br />(Per accident)
<br />AUTOS ONLYAUTOS ONLY
<br />$
<br />UMBRELLA LIABUMBRELLA LIAB 25,000,00025,000,000
<br />OCCUREACH OCCURRENCE$
<br />C EXCESS LIAB CUP9J43435010/01/202110/01/202210/01/202225,000,000
<br />CLAIMS-MADEAGGREGATE$
<br />DEDRETENTION$$
<br />PEROTH-
<br />WORKERS COMPENSATIONWORKERS COMPENSATION
<br />STATUTEER
<br />AND EMPLOYERS' LIABILITYAND EMPLOYERS' LIABILITY
<br />Y / N
<br />1,000,0001,000,000
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT$
<br />CN N / A UB-9P291231-21-14-E10/01/202110/01/202210/01/2022
<br />OFFICER/MEMBER EXCLUDED?
<br />1,000,000
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE$
<br />If yes, describe under
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$
<br />Limit of Insurance:$10,000,000
<br />EMPLOYEE THEFT
<br />D8225-995110/01/202110/01/2022Retention:$250,000
<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 #D96553468, 11/6/21-11/6/22. $10,000,000 Limit; $1,000,000 Deductible.Insurer E: Cyber Liability, Policy #D96553468, 11/6/21-11/6/22. $10,000,000 Limit;
<br /> $1,000,000 Deductible.
<br />Re: City of Santa Ana Employee Benefits Consulting Services Agreement 7/1/2021-7/30/2022.
<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 requiredThe City of Santa Ana,
<br /> its officers, officials, employees, or volunteers are included as additional insured on a primary and non-contributory basis if requiredThe City of Santa Ana, its officers, officials,
<br /> 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 and waiver of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30by written contract with respects
<br /> to General Liability and waiver of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30by written contract with respects to General Liability and waiver
<br /> of subrogation applies per Forms CG D4 11 04 08, CG T100 02 19 and CG D4 67 02 19. 30
<br />days' written notice of cancellation except 10 days for non-payment of premium plus mailing time will be granted.days' written notice of cancellation except 10 days for non-payment of
<br /> premium plus mailing time will be granted.
<br />CERTIFICATE HOLDERCANCELLATION
<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 />City of Santa Ana, Risk Management Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa AnaCA92702
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD
<br />
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