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A� H CERTIFICATE OF LIABILITY INSURANCE
<br />oAT2612018D/vrvr)
<br />06/26/2078
<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 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 />CONTACT
<br />NAME:
<br />Marsh Risk & Insurance Services
<br />_ _ _ - - _
<br />17901 Von Kaman Avenue, Suite 1100
<br />AdcNo AMIC No:
<br />_
<br />E-MAIL
<br />ADDRESS:
<br />(949) 399-5800; license #0437153
<br />Irvine, CA 92614
<br />Attn: NewportBeach.CertRequest@marsh.mm/F: 212-9484323
<br />INSURER(S) AFFORDING COVERAGE
<br />I NAIC#
<br />INSURER A: Cram & Forster Specialty Insurance Go
<br />144520
<br />CN11515B923-01-01-18-19
<br />INSURED
<br />PlaceWorks, Inc
<br />INSURERB: Travelers Property CasualtyComny Of America
<br />'25674
<br />— -
<br />-
<br />INSURERC:
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<br />Design Community &Enviomment F} ��ty-
<br />INSURERD :
<br />3 MacArthur Place, Suite 1100
<br />Santa Ana, CA 92707
<br />INSURER E:
<br />--
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: LOS-002212046-19 REVISION NUMBER: 9
<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 TYPE OF ADDL SUBR POLICYEFF POLICY UP -
<br />LTR POLICYNUMBER MMIDD/YYYYl (MMIDD[YYYYt LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY X X EPK122995
<br />�
<br />CLAIMS -MADE ' OCCUR
<br />07/01/2018 07/01/2019 EACH OCCURRENCE
<br />?AMA ET RENTED rre
<br />PREMISES Es occunce
<br />It 5,000,000
<br />$ 50,000
<br />$ 5,000
<br />ILX BI & PC Ded. $5,000
<br />MED EXP (Any one person)
<br />$ 5,000,000
<br />PERSONAL &ADV INJURY
<br />$ 5,000,000
<br />AGGREGATE LIMIT APPLIES PER-
<br />GENERAL AGGREGATE
<br />LGEN'L
<br />POLICY I--]JECOT El I
<br />PRODUCTS-COMP/OPAGG
<br />$ 5,000,000
<br />$ 5,000,000
<br />OTHER:
<br />Contractors Pollution
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BA7E37616718CAG
<br />07/0112018
<br />07101/2019
<br />COMBINED SINGLE LIMIT
<br />Ea acddeM
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)$
<br />PROPERTY DAMAGE $
<br />Per accident
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />Comp/Coll Deductibles $ $1,000
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EX6J3287561843
<br />07/01/2018
<br />07101/2019
<br />EACH OCCURRENCE $ 4,000,000
<br />X
<br />AGGREGATE
<br />g 4,000,000
<br />EXCESS DAB
<br />CLAIMS -MADE
<br />LIED
<br />RETENTIONS
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERAIEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />UB7K7286761843G
<br />V(IVIIZUIU
<br />07/01/2019
<br />X STAPER OT -
<br />TUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 100,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If Yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />8 1,000,000
<br />A
<br />Errors & Omissions -Claims Made
<br />EPK122995 07/0112018 07101/2019
<br />Each Claim/Aggregate
<br />5,000,000
<br />Retro Dates: See 2nd Page
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: Operations performed by the named insured for the certificate holder
<br />City of Santa Ana, its officers, agents, employees, and volunteers are included as additional insured where required by written contract with respect to General and Auto Liability. This insurance is primary and non-
<br />contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with raspe 64o General Liability. Waiver of subrogation is
<br />applicable where required by written contract with respect to General and Auto Liability. db�'t
<br />lata:.$lile/A$9
<br />City of Santa Ana
<br />20 Civic Center Plaza, M-36
<br />Santa Ana, CA 92701
<br />SHOULD ANY911I 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 Risk & Insurance Services
<br />Rosalynda Martinez IQ.
<br />reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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