|
Docusign Envelope ID: E360345A-EOA44122-A863-A57DF7B34CB0
<br /> CERTIFICATE OF LIABILITY INSURANCE r
<br /> ATE(MM/DDIYYYY)
<br /> 3/20/2025
<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 /> Arthur J.Gallagher Risk Management Services, LLC PHONE OUTFRONT Media Certificate Processing FAX
<br /> 500 N. Brand Boulevard o E t•818-539-2300 A/C No):818-539-1801
<br /> Suite 100 E-MAIL
<br /> ADDRESS: Certreguests@ajg.com
<br /> Glendale CA 91203 INSURERS AFFORDING COVERAGE NAIC#
<br /> License#:OD69293 INSURER A:ACE American Insurance Company 22667
<br /> INSURED INSURER B:ACE Pro e &Casual Insurance Co 20699
<br /> OUTFRONT Media Inc.
<br /> 90 Park Avenue, 9th Floor, INSURER C:Indemnity Insurance Company of N A 43575
<br /> New York, NY 10016 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2031472930 REVISION NUMBER:
<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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YY MMIDD/YYYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y HDO G48902595 6/l/2024 6/1/2025 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $2,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
<br /> )( PRO-
<br /> POLICY JECTPRO- LOC PRODUCTS-COMP/OP AGG S 4,000,000
<br /> OTHER: S
<br /> A AUTOMOBILE LIABILITY ISA H10819386 6/112024 6/1/2025 (Ea aBINEDISINGLE LIMIT $2,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY P
<br /> AUTOS ONLY AUTOS (Per accident) S
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> Comp/Coll.Ded $500.000
<br /> B X UMBRELLA LIAB X OCCUR XEU G28122810 009 611/2024 6/1/2025 EACH OCCURRENCE $5.000,000
<br /> EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $5,000,000
<br /> DED X RETENTIONS in onn $
<br /> C WORKERS COMPENSATION WLR C55521530 6/1/2024 6/1/2025 X I PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000
<br /> OFFICERIMEMBER EXCLUDED? NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 2,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000
<br /> Tu Tr n Tu n rally sign! APPROVED
<br /> D Tran Nguy
<br /> Dale:2025.0 18 '
<br /> Nguyen o9:23:77 By Tu Tran Nguyen at 9:18 am,Apr 18,2025
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached ii'more space is r
<br /> RE:Job Description:Santa Ana Agreement#A-2022-059.
<br /> The City,its officers,officials,employees,and volunteers are deemed an additional insured for General Liability,on a primary and non-contributory basis,as
<br /> respects the Named Insureds operations,if the Named Insured has agreed, prior to loss,to provide such coverage.Please refer to attached General Liability
<br /> endorsement for scope of Additional Insured status.Rights of Subrogation have been waived with respects to General Liability,Auto Liability and Workers
<br /> Compensation as required by written contract buy only as respects to operations of the Named Insured.Should any of the above-described policies be
<br /> cancelled before the expiration date thereof,the issuing company will mail thirty(30)days written notice to the Certificate Holder.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attention: Clerk of the City Council
<br /> 20 Civic Center Plaza (M-21) P.O. Box 1988 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana,CA 92702
<br /> ( f ©1988.2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|