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A+C® R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM /D DIYYYY) �„�- 12110 12014 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 be endorsed. If SUBROGATION 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 endorsement(s). PRODUCER CONTACT NAME: MARSH USA INC. PHONE FAX 122517TH STREET, SUITE 1300 Na DENVER, CO 80202 -5534 E -MAIL EACH OCCURRENCE ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A : XL Specialty Insurance Company 37885 11141 - INSCO- E -14 -15 INSURED GREAT- WEST LIFE &ANNUITY INSURER B : $ INSURER C : INSURANCE COMPANY AND SUBSIDIARIES 8515 EAST ORCHARD ROAD INSURER D : GREENWOOD VILLAGE, CO 80111 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: SEA - 00252095601 REVISION NUMBER:2 THIS IS TO 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY BEE MMIDD/YYYY POLICY EXP /DDVYYY MM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERALLIABILITY DAMA E TO RENTED PREMISES Ea accunence $ CLAIMS -MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OPAGG $ POLICY PRO LOC JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acci ant BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO RETENTION $ _ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR /PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ NIA E. L. DISEASE - EAEMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIP "rION OF OPERATIONS below E.L. DISEASE - POLICY AT $ A Miscellaneous ELU133729 -14 0313112014 03131/2015 Limit 10,000,000 Professional Liability Retention: $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: RECORDKEEPING & COMMUNICATION SERVICES 457B OC PLAN 498280 -1 ICE 19519 a 11 CITY OF SANTA ANA CIO FRANCISCO GUTIERREZ, EXECUTIVE DIRECTOR FINANCE & MANAGEMENT SERVICES 20 CIVIC CENTER PLAZA, M17 P.O. BOX 1988 SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer a -dV� © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD