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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D06/10ATE I/2021Y)
<br />06/10/2021
<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 endorsements).
<br />PRODUCER
<br />Willis Towers Watson Northeast, Inc.
<br />c/a 2fi Century Blvd
<br />P.O. Box 305191
<br />CONTACT Willis Towers Watson Certificate Center
<br />NAME:
<br />PHONE 1-877-945-7378 FAX 1-BBB-967-2378
<br />AIC No:
<br />ADD LESS. certificatesilwillis.com
<br />INSURERS AFFORDINGCOVERAGE
<br />NAIL#
<br />Nashville, IN 372305191 USA
<br />INSURERA: Great Northern Insurance Company
<br />20303
<br />INSURED
<br />CivicPlus, LLC
<br />302 S 4th Street, Suite 500
<br />INSURERS: Federal Insurance Company
<br />20281
<br />INSURERC: Westchester Surplus Lines Insurance Compan
<br />10172
<br />INSURERD:
<br />Manhattan, KS 66502
<br />NSURER E:
<br />NSURERF:
<br />COVERAGES CERTIFICATE NUMBER: w21237828 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />Jm
<br />POUCYNUMBER
<br />POLICY EFF
<br />I POLICY EXP
<br />MMIOnM
<br />LIMITS
<br />X
<br />COMMERCIALGENERALLABILITY
<br />CLAIMS -MADE OCCUR
<br />EACH OCCURRENCE
<br />$ 2,0 00,000
<br />PREMISES( aoneum
<br />PREMISES Ea oceurreime
<br />$ 2,000,000
<br />MED EXP(Any one arson)
<br />$ 30,000
<br />A
<br />pERSONALa ADV INJURY
<br />$ 1,000,000
<br />y
<br />3602-53-12
<br />05/17/2021
<br />05/17/2022
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />%(
<br />POLICY jRa LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILELIABILITY
<br />COMBINED SINGLE LIMIT
<br />Es accident
<br />$ 1,000,000
<br />BODILY INJURY (Per Pinson)
<br />$
<br />X
<br />ANY AUTO
<br />H
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />7358-87-92
<br />05/17/2021
<br />05/17/2022
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accdent
<br />$
<br />$
<br />B
<br />UMBRELLALRB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />X
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />7989-49-14
<br />05/17/2021
<br />05/17/2022
<br />DED X RETENTION 0
<br />$
<br />H
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNEWEXECUiNE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />N/A
<br />(22 ) ]779-92-99
<br />OS/17/2021
<br />05/17/2022
<br />X STATUTE ERH
<br />E.L. 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 />$ 1,000,000
<br />C
<br />Technology errors and Omissions
<br />F15611984 002
<br />04/30/2021
<br />04/30/2022
<br />Aggregate/ ded
<br />$5,000,000/$25,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />This Voids and Replaces Previously Issued Certificate Dated 05/18/2021 WITH ID: W20947704.
<br />The City of Santa Ana, Risk Management, it's Officers, employees, agents, representatives, and volunteers are included
<br />as Additional Insureds as respects to General Liability.
<br />General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Place, 4th Floor
<br />Santa Ana, 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 />ITHORD:EDREPRESENTATNE y RNIMpngeranl Oh4lan
<br />- N t REMEY/ED6/1rPRP'FD BY:
<br />81 1 ^
<br />7ou i7u7Jdr
<br />U 1UBB-2016 ACORD C(
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />a5 To: 21197135 BATCH: 2125567
<br />
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