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A-2020-241-33-02 Francine R. Villareal Digitally signed by Francine R. Villareal Date: 2021.07.1315:4153-07.00' A� " CERTIFICATE OF LIABILITY INSURANCE DATE Mil 062i2021DIYYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATIDN IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Marsh Risk & Insurance Services 17901 Van Korman Avenue, Suite 11 W (949) 399-5801 License M0437153 Irvine, CA 92614 CONTACT NAME AICCNno ExitFAX No E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAM 9 Atin: NewportBeach.CedRequmt@mamh.com/F. 212-9484323 INSURER A: Crum &Forster Specialty Insurance Cc 44520 CN115158923-01-01-21-22 INSURED PlaceWorks. Inc INSURER B: Travelers Property Casualty Co. Of America 25674 INSURER C: 3 MacArthur Place, Suite 1100 Santa Ana, CA 92707 _—--------- INSURER D: INSURERE: INSURER F: COVERAGES - CERTIFICATE NUMBER: LOS-002212046-27 REVISION NUMBER 12 THIS IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A DLSUBR g0 MO POUCYNUMBER POUCYEFF POLICY EXP MWDM^/ flMMflDDi LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR- X X EPK135992 0710V2021 07101/2022 EACH OCCURRENCE 5 5,00i DAMAGE TO RE R179— PREMISES Ea accunence $ 50,000 X MET E)(P (Any one person) S 5,000 BI & PC Ded. $5,000 PERSONALSAOVINJURV $ 5,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PRO- ECT � OC GENERAL AGGREGATE $ 5,000.000 GEN'L X - PRODUCTS - COMP/OPAGG 3 5.000,000 I Conhactors Pollution s 6,000,000 OTHER: I 0 AUTOMOBILE LIABILITY X X BA1N96106A2143G 07101/2021 07/0112022 COMBINED SINGLE OMIT Ea accident) g 1,000,000 X ANYAUTO BODILY INJURY (Par person) S - OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per amiden[ ( ) S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTVDAMAGE Per accident S ComplCall Deductibles s 1,000 UMBRELLA GAS X OCCUR EX6J3287562143 07101/2021 07/01/2022 EACH OCCURRENCE g 4.000,�0 X EXCESS LIAB CLAIMS -MADE AGGREGATE g 4,000,000 DED I I REfENMONS g B WORKERSCOMPENSATION AND EMPLOYERTUABILITY YtN U871<7286762143G 20 1 07/0112022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT g 1,000,000 AOFRCERIMEMBER EXCLUDED? NYPROPRIEfOWPARTNERIEXEGUTIVE NIA E.L. DISEASE -EA EMPLOYEd S 1,000,000 (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS bebw E.L. DISEASE -POLICY LIMIT 3 1,OIXLWO A Made ErrorRate EPK135992 0710112021 07/01/2022 Each ClaimlAggregate 5.000,000 D tes: See ranClaims Relro Dates: Sea rand Page DESCRIPTION OF OPERATIONS I LOCAMONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached X more space is required) ReOperations performed by the named insured for the Cer ihcate holler City of Santa Ana, its officers. agents, employees, and volunteers are included as additional insured where required by writer contract with respect to General and Auto Liability_ This insurance is primary and nm- conMbulory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to General Liability Waiver of sdlrogation is applicable where required by written contract with respect to General and Auto Liabilly. City of Santa Ana Risk Management Division 20 Civic Center Plaza. 4th Floor Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. of Marsh Risk & Insurance Services Rosalynda Martinez Rwsl ©1988-2016 ACORD C ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ R1deldmugeRmtEDhhion i RE)nEweci 6 APPRCvm By, I Z Il..Lv -Ara ®, Rkk Management Analyst