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Digitally signed by Fransme R.
<br />Francine R. Villareal Villareal
<br />Dace:20n o6.oi 1413.31 dTCO'
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />`i
<br />1 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 />PHONE (914) 761-9000 FAX
<br />pNo Ext: Arc, No: (914) 761-3749
<br />123 Main Street
<br />aoDREss: leanne.vezina@assured partners.com
<br />14th Floor
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC p
<br />White Plains NY 10601
<br />INSURERA: Charter Oak Fire Insurance Co
<br />25615
<br />INSURED
<br />INSURER B. The Travelers Indemnity Co.
<br />25658
<br />Keenan &Associates
<br />INSURER C : Travelers Property Casualty Company of Amedca
<br />25674
<br />c/o The Assured Partners Group, LP
<br />INSURER°: Federal Insurance Co.
<br />20281
<br />200 Colonial Center Parkway
<br />INSURER E: Ace Amedcan Ins. Co.
<br />37540
<br />Lake Mary FL 32746
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL20111362381 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 />Um
<br />TYPE OF INSURANCE
<br />AUDL
<br />INSR
<br />gUKK
<br />Me
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMIDOIYYYY
<br />POLICY E P
<br />MMIODIYYYY
<br />LIMITS
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE rx� OCCUR
<br />EACH OCCURRENCE
<br />$ 1.000,000
<br />PREMISES Ea occurrence
<br />$ 1.000,000
<br />MED EXP(Anyone pursing)
<br />$ 10,000
<br />PERSONAL a ADV INJURY
<br />$ 1.000,000
<br />A
<br />Y
<br />Y
<br />6301 C226998
<br />10/01/2020
<br />10/01/2021
<br />GENIAGGREGATE LIMITAPPLIES PER:
<br />X POLICY JE� LOC
<br />GENERALAGGREGATE
<br />$ 10,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2.000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,900
<br />BODILY INJURY (Per person)
<br />g
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BA6N912905
<br />10/01/2020
<br />10/01/2021
<br />BODILY INJURY Peraccident)
<br />S
<br />HIRED NO..WNEO
<br />AUTOS ONLY AUTOS ONLY
<br />q
<br />PROPERTY DAMAGE
<br />Per accident)$
<br />_S_
<br />—
<br />—
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 25,000,000
<br />C
<br />Excess LlAe
<br />CLAIMS -MADE
<br />CUP9J434350
<br />10/01/2020
<br />10/01/2021
<br />AGGREGATE
<br />$ 25.000,000
<br />OEO
<br />RETENTION $
<br />s$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N/A
<br />Ue-9P291231-20-14-E
<br />10101/2020
<br />10/01/2021
<br />PER _
<br />X STATUTE ERH
<br />L.
<br />E.EACH ACCIDENT
<br />$ 1,000.000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1-000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 11000,000
<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, maybe attached if more space Is mourned)
<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 7/112021-7/30/2022.
<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 ACOR
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />RiskManegernmL Division
<br />rR'EMEWED &AP1P'R.O'VVED BY:
<br />>`Aa%-Ult-,tip f AFWiN.I Z. vjt-VAt
<br />Risk Management Analyst
<br />
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