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FrancineR. wamnrdgned4ranm.k <br />Mlleed <br />Villareal oammei.nanzansla. <br />AC"R& CERTIFICATE OF LIABILITY INSURANCE <br />lh.,/ <br />DATE(MMIDONYYY) <br />1 10/15/2021 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Marsh & McLennan Agency, LLC <br />2000 Brookstone Centre Pkwy <br />CONTACT <br />Connie Whitmer <br />PHONE Faz <br />W. Ne E ' 706-324-6671 A/c No:706-576-5607 <br />Suite 118 <br />Columbus GA 31904 <br />ADDRESS: Connie.WhLmer MarshMMA.COm <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Federal Insurance Company <br />20281 <br />INSURED 30GLOSALPAYM <br />TSYS Merchant Solutions LLC <br />Global Payments, Inc. &It's Subsidiaries <br />INSURER B: Great Northern Insurance Company <br />20303 <br />INSURER C: ACE American Insurance Company <br />22667 <br />INSURERD: <br />One TSYS Way; C-4 <br />Columbus GA 31901 <br />INSURER E: <br />NSURER F : <br />COVERAGES CERTIFICATE NUMBER: 7008044H RFVIRIOM NUMRFR- <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 />ADOL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD <br />POLICY EXP <br />MWID <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FXIOCCUR <br />V <br />35MB071 <br />4/1/2021 <br />4/10022 <br />EACH OCCURRENCE <br />- <br />$1,000,000 <br />PREMIETORENrED <br />PREMISES 1E. bgEiinonce <br />$1,000,000 <br />MED EXP (Any oneperson) <br />$10,000 <br />PERSONAL It ADV INJURY <br />$1.000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY D PRO- <br />JECT LOG <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS - COMPIOP AGO <br />$2.000,000 <br />I Geri An. Can <br />$t00,ow,mo <br />OTHER: <br />I <br />B <br />AUTOMOBILE <br />LIABILITY <br />73614277 <br />N112021 <br />4/V2022 <br />COMBINED SINGLE LIMn <br />Ea accident <br />$ 00000 <br />BODILY INJURY (Par person) <br />$ <br />)t <br />ANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Per accident <br />1 ) <br />$ <br />X <br />AUTOS <br />HIRED AUTOS MX <br />Parracid. ROPERTY AMAGE <br />(Par <br />$ <br />%t <br />Hired ComeHired Call <br />Hired Phy Dm -ACV <br />$1.000 Deds <br />A <br />X <br />UMBRELLA LIAB <br />X IOCCUR <br />79804591 <br />411/2021 <br />4/1/2022 <br />EACH OCCURRENCE <br />$25.000,000 <br />AGGREGATE <br />$ 25,000,000 <br />EXCESS LIAB <br />El CLAIMS -MADE <br />OED X I RETENTION $ s,$ <br />X PER OTH- <br />STATUTE ER <br />NIA <br />71750292 <br />71750293 <br />411/2021 <br />411/2021 <br />411/2022 <br />V12022 <br />C <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUOEO7 N❑ <br />E.L. EACH ACCIDENT <br />$ 1,000,wo <br />E.L. DISEASE - EA EMPLOYEE <br />$1.000,000 <br />(Mandatory In NH) <br />If yes, describe under <br />E.L. DISEASE -POLICY LIMIT <br />$1,000poo <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana City, its officers, employees, agents, volunteers and representatives <br />(GL) Additional Insured perform: 80-02-2367 Additional Insured Scheduled Person or Organization <br />(GL) Primary and Noncontributory per form: 80-02-2653 Conditions — Other Insurance— Primary, Noncontributory Insurance Scheduled Person or <br />Organization <br />(GL) 45 Day Notice of Cancellation per form: 80-02-9779 Notice of Cancellation To Scheduled Persons or Organizations (Except Non-payment of Premium) <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Plaza 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 />AUTHORIZED REPRESENTATIVE <br />4 ACORD CI <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />WekMlmrgmloltDiWiw1 ' <br />ug REWED&APFROVm BY: <br />'aEVI <br />Risk Mlanageorent Anrrpt <br />