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Client#: 581763 0 II IFO NDI Ita I
<br />ACORD. CERTIFICATE A wMww71Li'�ISURAq&�g Y
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FON!! 11*1H2116 NO RIGHTS I . `O I� jC�r�tl l(I��
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E D OR ALTER THE C01 ER'' F O U11 P y+r
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE
<br />A CONTRACT BETWEEN T',E IS....����'1111����NG 1 SURE S T O E
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA HOLDER.
<br />Ia
<br />IMPORTANT: If the certificate holder is an ADDITIONAL I E , e
<br />o e s L INSUm- n orovisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and of
<br />a poll ain ici ay q
<br />r9'�4 d
<br />A 1
<br />this certificate does not confer any rights to the certific a ho a is
<br />su en a .l ).
<br />\J,©4,0�
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<br />PRODUCER
<br />CONTACNAME: T ROAD Jutierrez
<br />Marsh & McLennan Agency LLC
<br />HO
<br />PxoNENo, 949 900-1780 A'r
<br />Marsh & McLennan Ins. Agency LLC
<br />a,): AIC, No
<br />EJMAILADDREss: rocio.gutierrez@marshmma.com
<br />1 Polaris Way
<br />92
<br />AIiSO Viejo, CA 656
<br />INSURER(S) AFFORDING COVERAGE
<br />NAiCIf
<br />INSURER A: Federal Insurance Company
<br />20281
<br />INSURED
<br />INSURER B : Comp West Insurance Company
<br />12177
<br />Infond, Inc.
<br />INSURER c: Underwriters at Lloyd's London
<br />555555
<br />4240 E240 E La Palma Avenue
<br />Anaheim, CA 92807
<br />INSURER D:
<br />"
<br />INSURER E:
<br />COVERAGES CERTIFICATE NUMBER: RFVISInM NIIMRFa-
<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 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 />LT R
<br />LTSR
<br />TYPE OF INSURANCE
<br />ADD
<br />INSR
<br />SUBR
<br />WE)
<br />POLICY NUMBER
<br />POLICYEFF
<br />MMmON1
<br />POLICY EXP
<br />MMIDO
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />36031149
<br />-
<br />2/01/2022
<br />02MI2D2
<br />EACH
<br />�aJpe,
<br />$1 00 Aft
<br />�OCCURRENCE
<br />PREMISES Eaoccu ance
<br />$1 000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL B ADV INJURY
<br />$1,000,00X,a0
<br />GEN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />POLICYIGECT 171 LOC
<br />GENERALAGGREGATE
<br />$ O,M
<br />,
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />73587120
<br />2/01/2022
<br />0
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY(Per person)
<br />$
<br />ANY AUTO
<br />POMOBILELIABILFFY
<br />AUTOS ONLY AUTOSULED
<br />AUTOS ONLY X NON -OWNED
<br />AUTOS ONLY
<br />BODILY INJURY(Peraccidenl)
<br />$
<br />PERTY D
<br />PRPaOAMAGE r axitlent
<br />$
<br />$
<br />A
<br />X
<br />OMSRELLALIAB
<br />X
<br />OCCUR
<br />79896856
<br />2/01/2022
<br />EACH OCCURRENCE
<br />$'5 OOO OOO
<br />AGGREGATE
<br />$5000 0-O0
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORRERSCOMPENSATIe}L
<br />AND EMPLOYERS' LIABILITY
<br />YIN ANY PROPRIETOWPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />WCV5504862*
<br />WCV6217250**
<br />*CA/OR/AZ/GA
<br />2/01/2022'92f0fl21f23'XER
<br />2101/2022
<br />02/01/2023
<br />PER OTH-
<br />LaE
<br />E.L. EACH ACCIDENT
<br />$1,000000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, descdbe under
<br />DESCRIPTION OF OPERATIONS below
<br />y.;,
<br />FL/TX/IL
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />C
<br />*Prof Liab /Cyber
<br />TRICE01743
<br />02/01/2022
<br />02011202
<br />$5,000,000 Agg. /Claim
<br />C
<br />*Retro 12/01/06
<br />$100,000 Retention
<br />A ICrime
<br />1 1
<br />168054862
<br />02/01/2022
<br />02/01/2023
<br />$300,000 /$5,000 Ret.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents,
<br />volunteers and representatives are included as additional insured as respects to General Liability per
<br />attached endorsements. Waiver of Subrogation applies to Workers Compensation per attached endorsement.
<br />Primary and Non -Contributory Wording applies to General Liability per attached endorsement.Cancellation
<br />provisions apply per the attached.
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th floor
<br />SANTA ANA, CA 92701-0000 AUTHORIZED REPRESENTATIVE
<br />'OP+y„ RIAMarmartDWIslwt
<br />nREVIE &APPROVEDBY:
<br />©1988-2015 ACORO A-fi AcAliV44
<br />ACORD 25 (2016103) 1 Of 1 The ACORD name and logo are registered marks of AC-- •��' Risk Management specialist
<br />#S9285723/M9285467
<br />
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