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A� H CERTIFICATE OF LIABILITY INSURANCE <br />DATE <br />2/29 2017V V) <br />12/29/2017 <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(les) 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 />CONTACT Charter Risk Mana ement <br />NAME: g <br />HONE FAC <br />PUNIC <br />701 Market Street, Suite 1100 <br />No Ext) I No: <br />EMAIL certificaterequests@charter.com <br />ADDRESS: <br />St. Louis, NO 63101 <br />INSURER B AFFORDING COVERAGE NAIC p <br />3629906 <br />1/1/2018 <br />COMPANY A: National [Inion F1 re Ins Co P1tts urg PA 19445 <br />INSURED <br />COMPANY B: Commerce and Industry Insurance Company 19410 <br />Charter Communications, Inc. <br />400 Atlantic Street <br />COMPANY C: Ace Property & Casualty Insurance Company 20699 <br />COMPANY D: Insurance Company of State of 19429 <br />Stamford, CT 06901 <br />COMPANY E: New Hampshire Insurance Company 23841 <br />COMPANY F: American Home Assurance Company 19380 <br />COVERAGES CERTIFICATE NUMBER: 258Iuu REVISION NUMBER: <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 />TRINSD <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />MD <br />POLICYNUMBER <br />MMIDDY� <br />MMIDDI EXP <br />LIMITS <br />e <br />3629906 <br />1/1/2018 <br />1/1/2019 <br />EACH OCCURRENCE $ $1,000,000 <br />4COMMERCIALGENERALLIABIUTY <br />CLAIMS -MADE IX I OCCUR <br />X <br />PREMISES RENTED ance $ $500,000 <br />MED EXP (Any one person) $ $10, 000 <br />PERSONAL &ADV INJURY $ $1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ $3,000,000 <br />X <br />POLICY E JECTPHI- LOC <br />PRODUCTS-COMPIOP AGG $ $1,000,000 <br />$ <br />OTHER: <br />A <br />A <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />1921838 LAOS) <br />1921839 LMA) <br />1921840 (VA) <br />1/1/2010 <br />1/1/2018 <br />1/1/2018 <br />1/1/2019 <br />1/1/2019 <br />1/1/2019 <br />COMBINED SINGLE LIMIT $ $1,000,000 <br />Ea accident <br />BODILY I NJURV(Per person) $ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE $ <br />Par accident <br />C <br />X <br />UMBRELLA LIABX <br />OCCUR <br />X <br />G26119616003 <br />1/1/2010 <br />1/1/2019 <br />EACH OCCURRENCE $ 3,000,000 <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANVPROPRIETOWPARTNERIEXECUTIVE [—N] <br />OFFICERIMEMBEREXCLUDEDI <br />Md <br />(Mandatory In NH ) <br />11yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />See second page for <br />specific Policy <br />information. <br />1/1/2018 <br />1/1/2018 <br />1/1/2018 <br />1/1/2018 <br />1/1/2018 <br />1/1/2018 <br />1/1/2019PER <br />1/1/2019 <br />1/1/2019 <br />1/1/2019 <br />1/1/2019 <br />1/1/2019 <br />OTH- <br />STATUTE ER <br />EL EACH ACCIDENT $ $5,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ $5,000,000 <br />$5, a00, a0o <br />E. L. DISEASE -POLICY LIMIT $ <br />A <br />Exce55 WC OH ($5M Retention) <br />4595566 (OH) <br />1/1/2018 <br />1/1/2019 <br />Employers Liability $5,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Please see page 2 for additional insureds and any additional language. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />IT Manager, Mike Fenner <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92701 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />�o M <br />Joseph M. Lee <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />� 1�¢-�r�nn�er �o�� � �z� I►� <br />