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<br />Acil l2a® CERTIFICATE OF LIABILITY INSURANCE
<br />IIII
<br />°07/27/20 s °I " " ""
<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, As THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holde n = Di N - IN URf?, 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 end g). ,
<br />y5i
<br />PRODUCER r� rp ART
<br />�
<br />MARSH USA INC. CLERK OF COUI,','J �
<br />1050 CONNECTICUT AVENUE, SUITE 700
<br />CONTACT
<br />PHONE FAX
<br />A/C IN o. A/C, No),
<br />E-MAIL
<br />ADDRESS:
<br />WASHINGTON, DC 20036 -5386
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Phoenix Insurance Company
<br />25623
<br />040356 - FINPR -EO+FI -2017
<br />INSURED
<br />ICMA RETIREMENT CORP.
<br />ATTN: D'JUANA THOMAS
<br />INSURER B : N/A
<br />N/A
<br />wsuaER C: Travelers Casualty Insurance Co. Of America
<br />19046
<br />INSURER D : Federal Insurance Company
<br />20281
<br />777 NORTH CAPITOL ST., NE -
<br />WASHINGTON, DC 20002
<br />NSURER E St. Paul Fire &Marine Insurance Co.
<br />24767
<br />INSURER F
<br />$ 1,000,000
<br />X
<br />COVERAGES CERTIFICATE NUMBER: CLE- 004640666 -25 REVISION NUMBER:5
<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 />LTR
<br />UT
<br />TYPE OF INSURANCE
<br />Man ADDLSUBR
<br />POLICY NUMBER
<br />POLICY I DIYYV
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />6306E588375
<br />06/0112016
<br />06/01/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS MADE M OCCUR
<br />CONTRACTUAL COV. INCL
<br />DAMAGE TO RETED
<br />PREMISES (E. occurrence
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY_
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ET ❑ LOC
<br />J
<br />X ECT
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,009
<br />$
<br />OTHER
<br />44,
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />fEa acoldentl
<br />$
<br />_
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />_
<br />ALL OWNED SCHEDULED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident __ -_.___
<br />$
<br />— NOR OWNED
<br />HIRED AUTOS AUTOS
<br />�,\lIISSS"'
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />1
<br />$
<br />1
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR /PARTNER /EXECUTIVE YIN
<br />OFFICER EMBER EXCLUDED?
<br />/M
<br />(Mandatary in NH)
<br />N/A
<br />U0650810894
<br />08/01/2016
<br />0810112017
<br />X STATUTE OLTH
<br />E.L. EACH ACCIDENT
<br />—
<br />$ 1,000,000
<br />EL .DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />BANKERS PROF. LIAB,
<br />8211 -6261
<br />0613012016
<br />06/3012017
<br />$7,500,000 p1c, $12,500,000
<br />E
<br />SIR: $1,000,000
<br />ZPL- 71MO7549 -16 -N2
<br />0613012016
<br />06/30/2017
<br />$5,000,000 pla$12,500,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ATTN: EXECUTIVE DIRECTOR OF PERSONNEL SVS
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA IVF34
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANTA ANA, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Manashi Mukherjee _s- c..�........� _+..— ...�,..x..
<br />ACORD 25 (2014/01)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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