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,acaR °® CERTIFICATE OF LIABILITY INSURANCE DATE ' " " " "' 12/10/2014 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 MARSH USA INC. 122517TH STREET, SUITE 1300 CONTACT NAME' PHONE EM), ac No E -MAIL ADDRESS: DENVER, CO 80202 -5534 INSURERS AFFORDING COVERAGE NAICk INSURER A: Sentry Insurance A Mutual Co 24988 11141 - STND- AW -14 -15 INSURED GREAT WEST LIFE &ANNUITY INSURER B COMMERCIAL GENERAL LIABILITY INSURER C INSURANCE COMPANY & SUBSIDIARIES 8515 E. ORCHARD ROAD GREENWOOD VILLAGE, CO 80111 INSURER D : DAMAGE( RENTED PREMISES S Ea occurrence ) $ INSURER E: CLAIMS -MADE ❑ OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: SEA - 002520916 -01 REVISION NUMBER:6 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. MSR LTR TYPE OF INSURANCE ADD L JNM SUBR POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP (MMIDD/YYYY) LIMITS of Marsh USA Inc. GENERAL LIABILITY Sharon A. Hammer d✓ � EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE( RENTED PREMISES S Ea occurrence ) $ CLAIMS -MADE ❑ OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREJLIMIT APPLIES PER _ PRODUCTS - COMP /OP AGO $ POLICY PRO LOD CT $ A AUTOMOBILE LIABILITY 90- 04862.03(AOS) 12/0112014 1210112015 COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY(Per person) _ $ A ANY AUTO 90- 0486204 12)01)2014 1210112015 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accidenF $ NON -OWNED HIRED AUTOS X AUTOS It UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEO T7 RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- ELEL A A AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑N (Mandatory in NH) NIA 90- 04862- 01(ADS) 90- 048fi2 -02 HI, NY, WI, WV ( ) 12101/2014 1210112014 12(0112015 1210112015 E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) COVERAGE PROVIDED BY THE ABOVE AUTO LIABILITY POLICY SHALL BE PRIMARY AND IS LIMITED TO LIABILITY OF THE NAMED INSURED'S OWNERSHIP AND /OR OPERATIONS. v LILL_ 3oF� CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CIO FRANCISCO GUTIERREZ, EXECUTIVE DIRECTOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FINANCE & MANAGEMENT SERVICES ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER PLAZA, M17 P.O. BOX 1988 AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92702 of Marsh USA Inc. Sharon A. Hammer d✓ � ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD