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CER_T_IFI_CAT_E - -F LIABILITY INS- U- RANGE DATE(MMI °° YYY,
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />MARSH USA INC.
<br />CONTACT
<br />NAME'
<br />WASHINGTON, CUT AVENUE, SUITE 700
<br />WASHINGTON, DC 20036 -5386
<br />PHONE FAX
<br />c No ac No :
<br />E -MAIL
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 9
<br />040356- FINPR- EO,fl -15 -16
<br />INSURER A: Phoenix Insurance Company
<br />25623
<br />INSURED
<br />ICNIA RETIREMENT CORP,
<br />INSURER B: NIA
<br />-
<br />N/A
<br />INSURER C: Travelers Casualty Insurance Co. Of America
<br />19046
<br />ATTN: D'JUANA THOMAS
<br />777 HINGTO ,DC 2 002 NE
<br />WASHINGTON, DC 20002
<br />INSURER D: Federal Insurance Company
<br />20281
<br />INSURER E: SL Paul Fire 8 Marine Insurance Co.
<br />24787
<br />X
<br />INSURER F:
<br />$ 10,000
<br />' -' ���.Ywwry rvVIYIOCR:e
<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 />TYPE OF INSURANCE
<br />ADDL
<br />UBR
<br />ylya
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYVV
<br />POLICY E %P
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />F-1-1 OCCUR
<br />CLAIMS -MADE
<br />CONTRACTUAL COV. INCL.
<br />6306E588375
<br />O
<br />7l�
<br />0810112015
<br />08101/2016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES R a occurrence
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL 8 ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY 0 PRO- ❑ LOC
<br />JECT
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON HIRED AUTOS AUTOS OWNED
<br />AUTOS
<br />t
<br />'q 6
<br />.L J
<br />r't
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Par accident)
<br />$
<br />Pe,,,IdYDAMAGE
<br />Per accitleM
<br />$
<br />C
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS MADE
<br />IA
<br />U8650BM894
<br />08/01/2015
<br />08101/2016
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />OED RETENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE IM
<br />OFFICEREMBER EXCLUDED? M
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />X PER 0TH-
<br />STATUTE ER
<br />$
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,00
<br />0,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />E
<br />BANKERS PROF. LIAB.
<br />SIR: $1,000,000
<br />8211 -6261
<br />ZPL- 71M07549 -15 -N2
<br />06130/2015
<br />06/30/2015
<br />0613012016
<br />06/3012016
<br />$7,500,000 plo $12,500,000
<br />15,000,000 pi $12,500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space is required)
<br />CITY OF SANTA ANA
<br />ATTN: EXECUTIVE DIRECTOR OF PERSONNEL SVS
<br />20 CIVIC CENTER PLAZA M-34
<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 />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee �.,. _z
<br />© 1988 -2n14 ACORn CORP17)RATlr1n1 All . ;..r.._
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD V
<br />elz•111 5
<br />
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