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8 DATE (MM/DDIYYYY)
<br />'"RO CERTIFICATE OF LIABILITY INSURANCE 07/01/2024
<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 CONTACT
<br />Marsh Risk & Insurance Services NAME:
<br />PHONE FAX
<br />17901 Von Karman Avenue, Suite 1100(A/C, No Ext : A/C, No):
<br />(949) 399-5800; License #0437153 E-MAIL
<br />Irvine, CA 92614 ADDRESS:
<br />Attn: NewportBeach.CertRequest@marsh.com/F: 212-948-4323 INSURER(S) AFFORDING COVERAGE NAIC #
<br />CN115158923-01-01-24-25 INSURERA: 'rumMt i t n e • 20
<br />INSURED :rsNeOIe a U m ca 74
<br />PlaceWorks, Inc
<br />3 MacArthur Place, Suite 1100 INSURER C
<br />Santa Ana, CA 92707 I INSURER D : •
<br />INSURER E L) Y 1-%
<br />Acevedo-
<br />CnVFRAnFR
<br />CFRTIFICATF NIIMRFR- — I n.¢_nr> _ t _ RFVMIAW'1411MAFRr%i r7 `% 0%
<br />THIS IS TO CERTIFY THAT THE ICIES�.QLIINS AN E LI ED LOW E B r ISSUED
<br />^ y7 Q P4 RIOD
<br />INDICATED. NOTWITHSTANDIN A Y Vuulml F Civ i RACT
<br />OR O ,, :-o DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED ERT E R OR D T POLICIES
<br />EXCLUSIONS AND CONDITION OF S C MIT HO Y t UCED S1P&11
<br />DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />�L •
<br />07100
<br />INSR
<br />LTR
<br />OF INSURANCE
<br />ADDL�SUBRTYPE
<br />INSD
<br />WVn
<br />POLICY NUMBEF
<br />MM DDIYYPOLICYFF
<br />07/01/2024
<br />P /�
<br />07/01/2025
<br />• AM ITS
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />EPK148300
<br />CLAIMS -MADE X� OCCUR
<br />DAMAGE TO
<br />FIR SES Ea occurrDe...
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />BI & PD Ded. $5,000
<br />PERSONAL & ADV INJURY
<br />$ 5,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />❑ JECT PRO ❑ LOC
<br />NPOLICY
<br />PRODUCTS - COMP/OPAGG
<br />$ 5,000,000
<br />Contractors Pollution
<br />$ 5,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />X
<br />X
<br />BA-1N96406A-24-43-G
<br />07/01/2024
<br />07/01/2025
<br />COMBINED Ea accidentent)S LE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Comp/Coll Deductibles
<br />$ 1,000
<br />B
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EX-6J328756-24-43
<br />07/01/2024
<br />07/01/2025
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X
<br />AGGREGATE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? N❑
<br />(Mandatory in NH)
<br />N / A
<br />UB-7K728676-24-43-G
<br />07/01/2024
<br />07/01/2025
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Errors & Omissions -Claims Made
<br />EPK148300
<br />07/01/2024
<br />07/01/2025
<br />Each Claim/Aggregate
<br />5,000,000
<br />Retro Dates: See 2nd Page
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: Operations performed by the named insured for the certificate holder
<br />City of Santa Ana, its officers, agents, employees, and volunteers are included as additional insured where required by written contract with respect to General and Auto Liability. This insurance is primary and non-
<br />contributory over any existing insurance and limited to liability arising out of the operations of the named i nsured and where required by written contract with respect to General Liability. Waiver of subrogation is
<br />applicable where required by written contract with respect to General and Auto Liability.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Risk Management Division THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, 4th Floor ACCORDANCE WITH THE POLICY PRC
<br />Santa Ana, CA 92701 Risk MougmumtDiviaian
<br />AUTHORIZED REPRESENTATIVE z REVIEWED & APPROVED BY:
<br />i ��/�r"�``�
<br />'GGt�i¢K Risk Management Specialist
<br />@ 1988-2016 ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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