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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMMCNYYY)
<br />12/11/2024
<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 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
<br />CONTACT Joseph LaVecchia
<br />NAME:
<br />Fields Group Insurance Services LLC
<br />PHONE (646) 979-9010 l' 646 979-9011
<br />( )
<br />C No Exl : AI, No :
<br />c
<br />E-MAIL lavecchia fields Ins.com
<br />ADDRESS: ) gmu P
<br />110 East 42nd Street
<br />16th Floor
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIL#
<br />New York NY 10017
<br />INSURERA: Hartford Underwriters Insurance Company
<br />30104
<br />INSURED
<br />INSURER S: Hartford Fire Insurance Company
<br />19682
<br />Kaizen Laboratories Inc.
<br />INSURER C :
<br />17 W 20th St
<br />INSURER p
<br />INSURER E
<br />New York NY 10011-3702
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CL2472403514 RFVIAIOM MIIMRFR-
<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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AIJUL
<br />INSD
<br />sees
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDE
<br />POLICY UP
<br />MMIDDIYYYY
<br />LIMITS
<br />x
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1 OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES (Ea mcunence
<br />$ 1,000,000
<br />MED UP (An one per .r)
<br />$ 10,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />A
<br />Y
<br />Y
<br />10SBABG5W82
<br />05/24/2024
<br />05/24/2025
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY ❑ jEo- LOC
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Es accident)
<br />$ 1, 000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />AOWNED
<br />SCHEDULED
<br />AUTOS ONLY AUTOS
<br />IOSBABG5W82
<br />05/24/2024
<br />05/24/2025
<br />POMOBILE
<br />BODILY INJURV(Per accident)
<br />$
<br />HIRED x NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident)
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />10SBABG5W82
<br />05/24/2024
<br />05/24/2025
<br />AGGREGATE
<br />$ 2,000,000
<br />DED X RETENTION $ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED]
<br />NIA
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatary In NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Tech Errors and Omissions, Cyber
<br />10 TE 0654549-24
<br />05/24/2024
<br />05/24/2025
<br />Each Occurrence
<br />$2,000,000
<br />General Aggregate
<br />$3,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached N more space is required) ,3se=11,
<br />Tu Tran c", '.'�
<br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement,
<br />or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City shall be excess and Nguyen"".,.
<br />noncontributory. sns.�zep>•m
<br />City of Santa Ana / Kaizen Laboratories Inc. / Recreation Management Software APPROVED
<br />30 Day Notice of Cancellation Included. By Tu Trsn Nguyen at 7:54 am, Mar 10, 2025
<br />City of Santa Ana
<br />Timothy Pagano, Recreation Deputy Director
<br />20 Civic Center Plaza M-23
<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 />r l9IRi0 ACUKU CUKPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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