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HomeMy WebLinkAboutCENTERRA GROUPINSURANCE ON FILE WORK MAY PROCEED N-2022-307 UNTIL INSURANCE EXPIRES I�• �- zgi CLERK OF COUNCIL DV4- Agreement for Use of the Santa Ana Police Department Range Facility N O RThis agreement is made and entered into on the 1" day of October, 2022, by and between the, Centerra Group, LLC, a Delaware limited liability company ("GROUP") and the City of Santa Ana, a City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("CITY"). This agreement will expire on ® September 30, 2025. Pd Cmg4lam 3)mm) k RECITALS 1. CITY has constructed and operates a police pistol range located on its property at 60 Civic Center Drive, Santa Ana California, (hereinafter referred to as "the Facility'); and 2 Santa Ana Police Department employees are responsible for management and operation of the Facility (hereinafter referred to as "Santa Ana Rangemasters"); and 3. CITY has promulgated certain rules and regulations (See Exhibit A) concerning safety, operation and use of the Facility; and 4. The GROUP desires to enter into an Agreement with CITY permitting the GROUP to use the Facility. 5. The GROUP desires to use the Facility to conduct firearms training/qualifications due to it being centrally located between their operational facilities located in Los Angeles and Orange Counties. COVENANTS NOW THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows: 1. CITY agrees to allow those officers, employees and agents of the GROUP who are authorized by the GROUP to use the Facility as specified in this Agreement. 2. The GROUP agrees to provide CITY with a list of all GROUP officers, employees, and agents authorized to use the Facility. Only those persons specified on the authorization list may use the Facility. Additions to or deletions from the authorization list shall be provided to CITY on a monthly basis. The GROUP shall take all reasonable measures to assure that only those persons specified on the authorization list shall be permitted to use the Facility. Group shall be solely responsible for providing updated lists to the City detailing any changes which authorize or remove GROUP personnel from using the Facility. The authorization list is for informational purposes only and CITY shall have no obligation to screen or to otherwise evaluate the qualifications, other than for safety, of those persons authorized to use the Facility. All screening procedures to qualify those who use the Facility shall be the sole responsibility of the GROUP. Page 1 of 10 All officers, employees and agents of the GROUP who use the Facility, shall strictly comply with the rules and regulations, attached hereto as Exhibits A and B", including any amendments to Exhibits A or B, and any other policy, order. directive, or Council approved action of CITY. CITY shall supply the GROUP with a copy of all rules, regulations, and amendments which are not included in Exhibits A or B. 4. Unless otherwise agreed, the GROUP shall provide a Contract Agency Rangemaster, (hereinafter referred to as "CAR") to supervise the range operation and conduct firearms training as required. In the event a CAR is unavailable, CITY agrees to provide a department certified Rangemaster and GROUP agrees to request the services of a Santa Ana Rangemaster a minimum of 14 days prior to the scheduled training. In the event a Santa Ana Rangemaster is requested and utilized, CITY agrees to provide a Firearms Training Course that has been approved by the Santa Ana Training Commander. CITY will provide a written copy of the Firearms Training Course to GROUP to facilitate the documentation of firearms training by their personnel. 5. The Santa Ana Rangemaster may close the Facility at any time for any purpose. The Santa Ana Rangemaster may exclude any person from using the Facility for violating any rules and regulations relating to safety. CITY reserves the exclusive right to determine the Facility's hours of operation. The GROUP may, upon prior approval of the Santa Ana Rangemaster, use the Facility outside the hours of operation providing there is no conflict with other agency use of the Facility. 6. The GROUP agrees to pay in accordance with the rates set forth in Exhibit C. The total revenue to City based upon use of the Facility during the term of this Agreement shall not exceed $30,000. CITY reserves the right to adjust any fees, upon 20 days prior written notice, as necessary to cover any increased cost related to the use of the Facility. Any fee increase shall not be greater than any increase that may be imposed upon any other agency authorized to use the Facility. Any increase which would increase the total revenue during the term of this Agreement is subject to Amendment to this Agreement. The parties agree and understand that such an amendment may be subject to the approval of the City Council for the City of Santa Ana. 8. The GROUP agrees to notify CITY of its intent to cancel any previously scheduled facility use at least 24 hours before the scheduled date. If previously scheduled facility time is not canceled at least 24 hours prior to the scheduled date, the GROUP, agrees to pay a $50.00 forfeiture fee. 9. CITY shall submit an invoice to the GROUP and the GROUP agrees to make payment to CITY on or before 30 days from the date of the invoice. Delay of prompt payment may result in Facility use denial. 10. CITY shall not be liable for any loss, damage or injury of any kind whatsoever to the GROUP, its property, or to any of its officers, employees, agents, guests or invitees, or any other person, caused by any use of the Facility, or by any defect in any building, structure or any other Page 2of10 improvement at the Facility or arising from any accident on the premises. The GROUP waives, all claims and demands against CITY for any such loss, damage, or injury. The GROUP hereby agrees to defend and 'indemnify, save and hold CITY free and harmless from any liability for any loss, damage or injury to the GROUP officers, employees, and agents, other persons or property, and from all costs, expenses and other charges arising from the GROUP use of the Facility in connection with this Agreement, except the GROUP shall not be required to indemnify for any loss, damage, injury or claim arising from the willful acts or negligence of CITY, its officers, employees, or agents. 11. The GROUP agrees and represents that all of its officers, employees, agents, or other personnel that may utilize the Facility are doing so within the course and scope of their duties as an employee, officer, or agent of the GROUP and are in no way employees of CITY. Should any officer, employee, agent or other personnel of the GROUP submit a claim for any injury or damages relating to the use of the Facility, the GROUP agrees to indemnify CITY from any and all such claims whether made by way of civil litigation, tort claim, arbitration or by the workers' compensation forum except that the GROUP shall not indemnify CITY for any loss, damage, injury, or claim arising from the willful acts or negligence of CITY, its officers, employees or agents 12. Either party may terminate this Agreement, without cause upon 30 days prior written notice. 13. The persons executing this Agreement on behalf of the GROUP and CITY warrant that (i) they are duly authorized to execute and deliver this Agreement, (ii) formally bound to the provisions of this Agreement, and (iii) entering into this Agreement does not violate any provisions of any other agreement to which the party is bound. 14. Insurance - GROUP shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the GROUP, his agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: • Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. • Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. If the GROUP maintains broader coverage and/or higher limits than the minimums shown above, the CITY requires and shall be entitled to the broader coverage and/or the higher limits Page 3 of 10 maintained by the GROUP. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the CITY. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The CITY, its officers, officials, employees, and vohmteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the GROUP including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the GROUP's insurance (at least as broad as ISO Form CG 20 10 11 85 or if notavailable, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 2037 if a later edition is used). Primary Coverage For any claims related to this contract, the GROUP's insurance coverage shall be primary coverage at least as broad as ISO CG 20 0104 13 as respects the CITY, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the CITY, its officers,officials, employees, or volunteers shall be excess of the GROUP's insurance and shall not contribute with it. Notice of Cancellation Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the CITY. Waiver of Subrogation GROUP hereby grants to CITY a waiver of any right to subrogation which any insurer of said GROUP may acquire against the CITY by virtue of the payment of any loss under such insurance. GROUP agrees to obtain any endorsement that maybe necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the CITY has received a waiver of subrogation endorsement from the insurer. Self -Insured Retentions Self -insured retentions must be declared to and approved by the CITY. The CITY may require theGROUP to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or CITY. Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the state with current A.M. Best's rating of no less than ANII, unless otherwise acceptable to the CITY. Claims Made Policies (note — should be applicable only to professional liability, see below) If any of the required policies provide claims -made coverage: Page 4of10 1. The Retroactive Date must be shown, and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the GROUP must purchase "extended reporting" coverage for a minimum of five (5) years after completion of work. Verification of Coverage GROUP shall furnish the CITY with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage requiredby this clause) and a copy ofthe Declarations and Endorsement Page of the CGLpolicy listing allpolicy endorsements to CITY before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the GROUP's obligation to provide them. The CITY reserves the right to require complete, certified copies of all required insurance policies,including endorsements required by these specifications, at any time. Special Risks or Circumstances CITY reserves the right to modify these requirements, including limits, based on the nature of therisk, prior experience, insurer, coverage, or other special circumstances [signature page to follow] Page 5 of 19 IN WITNESS WHEREOF, the parties have executed and entered into this Agreement by their authorized representatives. ATTEST: Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: ljaow::=� Tamara Bogosian Senior Assistant City Attorney David of Police Fill _1 1 I O&A CITY OF SANTA ANA KRISTINE RIDGE City Manager CENTERRA GROUP, Jose 7Mronio Perez, 7strict Supervisor Page 6 of 10 EXHIBIT A Rules and Regulations for Use of the Santa Ana Police Department Range Facility 1. REGULATIONS FOR USE OF THE SAPD RANGE FACILITY BY CENTERRA LLC PERSONNEL a. All authorized personnel shall sign -in prior to using the facility. b. All personnel shall be authorized to use the facility under the following conditions: Personnel must be supervised by a certified Rangemaster during all firearms training. The Rangemaster may either be a CAR or a Santa Ana Police Department Rangemaster. All personnel are restricted to the area in and around the range facility. c. Facility hours will be by mutual consent and arranged at least 72 hours prior to use (exceptions can be made by Santa Ana Police Department Rangemaster). d. All personnel who are not in uniform shall wear a visible police badge or agency identification card at all times while in the Police Facility. 2. CONTRACT RANGE OPERATION CONDITIONS a. A Santa Ana Police Department Rangemaster will be present during all operations of the Facility and will have ultimate range authority over all users. b. Rangemasters may provide remediation of marksmanship related shooting problems as needed if desired, and as time permits. c. SAPD shall approve all ammunition used on the Facility prior to it being fired. No centerfire rifle caliber ammunition shall be permitted. d. SAPD may supply targets. e. SAPD will supply ear and eye protection. f. SAPD will supply weapon -cleaning facilities. g. SAPD may provide secure storage for GROUP ammunition and cleaning supplies. h. It shall be the responsibility of the CAR to ensure all weapons used at the facility are safe and in serviceable condition. 3. SAPD POLICIES All GROUP personnel shall comply with all applicable provisions of the City of Santa Ana Range Safety Policy. SAPD will be responsible to provide GROUP any updates and/or changes to policies and procedures governing Range Facility use and conduct. GROUP personnel are responsible for maintaining policy awareness and knowledge of any changes to Range Facility policies and Page 7 of 10 procedures of either Department. 4. RANGE OPERATION The Facility shall be operated in accordance with the following: a. The Santa Ana Rangemaster shall have the sole authority on the Facility and is responsible for its safe and efficient operation. b. All persons entering the Facility shall follow the directions of the Santa Ana Rangemaster and shall adhere to the posted rules. c. The Facility is for the use of SAPD personnel, contract agencies, and others as approved by the Chief of Police, Administration or the Training Commander. d. The Facility shall only be used under the supervision of an approved Santa Ana Rangemaster, or another qualified instructor as approved in writing by the Training Commander. e. All weapons cleaning will he carried out in the designated cleaning rooms. f. Unsafe practices will not be tolerated. Weapons shall be cleared and checked, using the firing lines under the supervision of an approved Rangemaster, or the weapon -clearing barrel before cleaning. The loading/unloading of firearms shall only be carried out using one of the safety barrels located in the Range, cleaning rooms, or on the firing line under the supervision of a Rangemaster. 5. WEAPONS The following policy and procedures apply to all weapons used in the Facility: a. The Santa Ana Rangemaster shall inspect all weapons that are being shot for the first time before they are fired on the Range. b. While shooting on the Range, or while in the immediate vicinity of an in -progress firearms course, all personnel shall wear eye and ear protection. c. Once weapons are loaded in preparation for shooting, they shall remain holstered unless on the firing line ready to shoot and/or participating in a course of fire (Hot Range Format). d. Only authorized weapons and ammunition shall be fired. e. The following equipment restrictions apply: 1. Authorized weapons are handguns up to and including .45 cal. 2. Magnum ammunition, tracer, incendiary, or armor piercing ammunition is strictly prohibited from being used in the Facility. Page 8 of 10 6. RESPONSIBILITIES Santa Ana Rangemasters and CAR's shall abide by the following: a. All Instructors shall demonstrate a proactive safety attitude and exhibit a professional demeanor at all times while in the Facility. b. Allow no one to use the Facility that has a pre-existing injury or condition(s), which may affect their ability to safely use the Facility or participate in firearms training. c. Any intentional violation of safety guidelines, gross displays of improper range procedures or lack of sound judgment, which in the Rangemasters opinion places others at risk of injury, shall result in the immediate removal of the individual(s) from the Facility. d. The Santa Ana Rangemaster on duty shall be responsible for inspecting the Facility before and after use by an outside agency. This inspection will include cleanliness and serviceability of equipment. Damage and or cluttered conditions will be brought to the attention of the CAR for correction � �IJ.IIIuI.Y�flIf, IO112 Firearms training shall be conducted under the following conditions: a. GROUP personnel shall only be trained using approved Firearms Training Courses and or Training Scenarios which have been approved by the SAPD Training Commander. SAPD reserves the right to deny or request modification to any course of fire if it is determined the course may be dangerous to personnel or damaging to range property and or equipment. b. Tactical training will not be conducted in the Facility unless it has the prior approval of the SAPD Training Commander and is conducted under the direct supervision of the SWAT Commander or their designee. c. The Santa Ana Rangemaster or the SAPD Training Commander are the authority concerning range safety, policy, and use. Decisions made by any Santa Ana Rangemaster shall be followed. Disputes and or controversial decisions may be referred to the Department's full time Santa Ana Rangemaster for resolution. Matters beyond the Rangemaster's authority shall be referred to the Training Commander during daytime working hours or the Watch Commander after hours. 8. EXCEPTIONS Waivers or exceptions to the above policies and guidelines shall only be authorized by the Chief of Police, or their designee. Page 9 of 10 EXHIBIT B SANTA ANA POLICE DEPARTMENT RANGE FACILITY INDIVIDUAL WAIVER OF LIABILITY The City of Santa Ana and the Santa Ana Police Department assume no obligation in offering the use of its Range Facility. There is a possibility of injury occurring when using the Facility. I, the undersigned, acknowledge and affirm that the handling of firearms, or being in the proximity of others using or handling firearms involves a significant risk of serious physical injury including the possibility of death regardless of the skill of the user or the adequacy of supervision or the instructions given. I fully understand and accept that my voluntary signature constitutes a request for permission to use the Facility with knowledge and understanding that I fully assume the risk that I am subject to possible injury at the Facility. I understand that by signing this form: a I understand and agree to assume all risks of physical injury arising out of my use of firearms and other related equipment, or participation, in the activities offered by the City of Santa Ana; b. I am waiving my rights with respect to any injury or damage I may sustain as a result of my use of the Facility, or while on premises when others are using the Facility. I am waiving my right to sue for inadequate instruction, inadequate supervision, faulty equipment, or dangerous condition of the premises. My agreement to waive the right to sue the City of Santa Ana does not extend to fraud or intentional misconduct of the City of Santa Ana or their officers, agents, employees and representatives; c. I agree to indemnify, defend and hold harmless the City of Santa Ana or its officers, agents, employees, and the Santa Ana Police Department fiom any and all damages, claims or losses caused by my use of the Facility. d. I agree to comply with all posted Facility rules and regulations and all orders. I have read this form and fully understand its content. Printed Name Badge # Signature Agency SAPD Witness Date SAPD Witness Signature Page 10 of 10 EXHIBIT C Range Use and Rangemaster Fees A. Range Fees a. $50 per hour (two hour minimum) b. $370 (total cost for eight consecutive hours of use) c. $50 (forfeiture fee in event use not canceled within 24 hours) B. Rangemaster Fees a. $90 per hour (two hour minimum) b. $700 (total cost for eight consecutive hours) Page 10 of 10 S:agllay%TracY heeqby Acowe CERTIFICATE OF LIABILITY INSURANCE JdCObS r L� 1s:4#.a9 63R?d 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 have ADDITIONAL INSURED provisions or 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 Willie Towers Watson Midwest, Inc. c/o 26 Century Blvd P.O. sox 305191 CONTACT Willis Towers Watson Certificate Center NA: INC.PHONE 1-877-945-7378 AIC.N.1: 1-888-467-2378 EAD-MAIL DRESS: cortificates@willia.com INSURERS AFFORDING COVERAGE NAIC# Nashville, IN 372305191 USA INSURERA: St.. Surplus Linea Insurance Company 13604 INSURED Centerra Group, LLC INSURER B: St— Indemnity S Liability Company 38318 1353D Dulles Technology Drive INSURER C: INSURERD: Suite 500 Herndon, VA 20171 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: W25793937 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDLSUBR J= MD POLICY NUMBER POLICY EFF fMMUDDNYYYIMMIDD POLICY UP LIMITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X CLAIMS -MADE OCCUR TO PREMI PREMISES AMAGES(RENTEDEa occurrence) $ 1,000,000 MEO UP (Any one parson) IS A PERSONAL S ADV INJURY $ 11000,000 B080114907U21 11/01/2021 11/01/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 11000,000 POLICYPRo- JECT LOC PRODUCTS-COMP/OP AGG $ 11000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHUTOS EDULED AUTOS ONLY A BODILY INJURY (Per acddant) $ HIRED NON -OWNED AUTOS, AUTOS ONLY PROPERTY DAMAGE Par accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNEWEXECUTIVE No OFFICERIMEMBEREXCLUDED7 (Mandatory in NH) NIA 100 0001596 11/01/2021 11/01/2022 X PER OTH- STATUTE ER E.LEACHACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1, 000,000 If yes, describe under DESCRIPTION OF OPERATIONS he.. E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 e Workers Compensation S 100 0001594 11/01/2021 11/01/2022 E.L. Each Accident: $1,000000 Employers Liability E.L. Disease -Ea Empl: $1,000:000 Pei Statue E.L. Disease-Pol lout: $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED City of Santa Ana Police Department Firing Range 60 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD arsmwgev¢wuoa qI REVIEWED& APPROVED BY: T4"Cy aACOe7 SR In: 23018874 snrcR: 2655969 AGENCY CUSTOMER ID: LOC #: AC"R" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Midwest, Inc. Centerra Group, LLC 13530 Dulles Technology Drive Suite 500 POLICY NUMBER See Page 1 Herndon, VA 20171 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVEDATE: See Page 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company POLICY NUMBER: 100 0001595 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation a E.L. Each Accident: $1,000,000 Employers Liability E.L. Disease Ea. Emp: $1,000,000 Per Statute E.L. Disease-Pol Lmt: $1,000,000 INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company POLICY NUMBER: 100 0004398 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation 6 E.L. Each Accident: $1,000,000 Employers Liability E.L. Disease -Ea Empl: $1,000,000 Per Statue E.L. Disease-Pol Lmt: $1,000,000 INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company POLICY NUMBER: 100 0003048 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation 6 E.L. Each Accident: $1,000,000 Employers Liability E.L. Disease -Ea Empl: $1,000,000 Per Statue E.L. Disease-Pol Lmt: $1,000,000 ACORD 101 (2008101) © 2008 ACORD The ACORD name and logo are registered marks of ACORD SR ID: 23018874 BATCH: 2655969 CERT: W25793937 NAIC#: 38318 NAICN: 36318 NAIC#: 38318 wrnwegmWr¢uovon REVIEWEDSAPPROVEDBY: T4" Jk4 ® Risk Management Analyst