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Digitally signed by
<br />Anaie
<br />ACORO� '
<br />Li CERTIFICATE OF LIABILITY H)ate:2022.08.04
<br />D080312022DryYYn
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPbk WVCMiVICATE 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
<br />MARSH USA INC,
<br />1050 CONNECTICUT AVENUE, SUITE 700
<br />WASHINGTON, DC 20036�5386
<br />CONTACT
<br />NAME:
<br />PHONE FAX(MC,No
<br />EfAHIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAM #
<br />INSURER A : Great Northern Insurance Company
<br />20303
<br />CN101976702-MULTI-.-22-23
<br />INSURED
<br />MISSIONSOUARE RETIREMENT
<br />INSURER a: Federal Insurance Company
<br />20281
<br />INSURER C : Travelers Casualty And Surety Company Of America
<br />31194
<br />777 NORTH CAPITOL ST., NE
<br />WASHINGTON, DC 20002
<br />INSURER O:
<br />INSURERE:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: CLE-006901158-08 REVISION NUMBER- 10
<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
<br />LTR
<br />TYPEOFINSURANCE
<br />ADOLSUSR
<br />IRM
<br />WD
<br />POUCYNUMBER
<br />POLICYEFF
<br />flummogri
<br />POLICYEXP
<br />rysvrm
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL L[ABILITY
<br />CLAIMS -MADE OCCUR
<br />3604-49-95
<br />08/01/2022
<br />080112023
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TOR
<br />PREMISES Eaoccmedical
<br />$ 1,000,000
<br />X
<br />MED FXP (Any oneperson)
<br />$ 10,000
<br />CONTRACTUAL COV. INCL.
<br />PERSONAL a ADV INJURY
<br />$ 1,000,000
<br />GENIE
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POUCV PRP JECTFx_] LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOSILELIABILITV
<br />736045-48
<br />08/01/2022
<br />08/01/2023
<br />COMBINED SINGLELIMIT
<br />Ea accident
<br />$ 1,000000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />( 1
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />PROPERTVDAMAGE
<br />Per accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />9364-77-37
<br />08/01/2022
<br />08/01/2023
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIM&MADE
<br />DID RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICEMMEMBEREXCLUDED? ❑N
<br />NIA
<br />7176-3685
<br />08/0112023
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />B
<br />BANKERS PROF. LIAB.
<br />8211-6261
<br />06/30/2022
<br />06/30/2023
<br />$7,500.000 pi$12.500,000
<br />C
<br />SIR$1,000,000
<br />106758967
<br />06/30/2022
<br />06/3012023
<br />$5,000,000 p/0$12,500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />City of Santa Ana are included as additional insured where required by written contract with respect to General Liability. Waiver of subrogation is applicable where required by written contract with respect to
<br />general liability and Workers Compensation. General abiliry insurance is primary and noncontributory over any existing insurance and limited to liability arising out of the operations of the named Insured subject
<br />to policy terms and conditions.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<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 />!E
<br />©1988-2016 ACORD
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />Risk Management Division
<br />REVIEWED Is APPROVED BY.
<br />=1117�11iL' A+�:a Acau+�D
<br />�'.
<br />- Risk Management Specialist
<br />01
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