|
Ol holly signed by F,annneR
<br />Francine R. Villareal Villareal
<br />rate: 20211s.0112:1331 oTOW
<br />Aac ® Ill CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIOOMW)
<br />��
<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(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 />PRODUCER
<br />CONTACT Jeanne Vezina
<br />NAME:
<br />AssuredPartners Northeast, LLC
<br />plc No (914)761-3749
<br />(914)e.vezinaassure
<br />Ezt: (A, Np:
<br />123 Main Street
<br />@ P761-9000
<br />EMAIL eannd artnem.com
<br />ADDRESS: I
<br />14lh Floor
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC4
<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 />INSURERC: Travelers Property Casualty Company ofAmenca
<br />25674
<br />c/o The Assured Partners Group, LP
<br />INSURER D: 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: 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 />INS
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />Me
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -NUDE � OCCUR
<br />RRENCE
<br />$ 1,000,000
<br />Ea occurrence
<br />$ 110001000
<br />ny one person)
<br />$ 10,000
<br />ADV INJURY
<br />MGENE�LAGGREGATE
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />6301C226998
<br />10/01/2020
<br />10/01/2021
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO LOC
<br />JECTOTHER:
<br />GREGATE
<br />$ 10,000,000
<br />-COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />SINGLE LIMIT
<br />E... ident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />6
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BA6N912905
<br />10/01/2020
<br />10/01/2021
<br />BODILY INJURY (Par accdent)
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />n
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 25,000,000
<br />AGGREGATE
<br />$ 25,000,000
<br />C
<br />EXCESS LIAR
<br />ICLAIMS-MADE
<br />CUP9J434350
<br />10/01/2020
<br />10/01/2021
<br />DEO
<br />I I RETENTION $
<br />S
<br />1
<br />C
<br />WORKERS COMPENSATION Y
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE �
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />UB-9P291231-20-14-E
<br />10/01/2020
<br />10/011202,
<br />PER OTH-
<br />X STATLFFE Eft
<br />E.L. EACH ACCIDENT
<br />S 1,000.000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1.000,000
<br />E.L. DISEASE - POLICY LIMIT
<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 I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Insurer E: Cyber Liability, Policy #D94933262, 11/6120-1116/21. $10,000,000 Limit, $250,000 Deductible.
<br />Re: City of Santa Ana Employee Benefits Consulting Services Agreement 7/112021-7/3012022.
<br />The City of Santa Ana, its officers, officials, employees, or volunteers are included as additional insured on a primary and noncontributory basis if required
<br />by written contract with respects to General Liability. Awaiver 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 />10
<br />U-1:i:11171bZ[K11]T
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />RiakMmugemmtDlWlon
<br />ell REVIEWED S {{APPROVED BY}
<br />r F'1a1M1fMZ h. VtL(//14((.
<br />�.
<br />® Risk Management Malys[ '-
<br />
|