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HomeMy WebLinkAboutMONUMENT (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURA CE EXPIRES MAYOR CITI' CLERK y� Valerie Amezcua MAYOR PRO TEM DATE. APR 1 8 2015 Benjamin Vazquez COUNCILMEMBERS ll•�Nji"�t) Phil Bacena l� ourq Johnathan Ryan Hernandez Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza . P.O. Box 1988 Santa Ana, California 92702 wwW.santa-ana.orD March 25, 2025 Monument Attn: Amber Costello, President 200 Spectrum Center, Ste. 300 Irvine, CA 92618 A-2022-077-04A CITY MANAGER Alvaro Nuriez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Re: Extension of Agreement No. A-2022-077-04 to provide on -call right of way services: property management services Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Monument ("Consultant"), and the City of Santa Ana, dated May 17, 2022, the time period of the Agreement is hereby extended for an additional one-year period through May 16, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terns and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, ,Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF S A ANA Alvaro Nunez City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney / 1i Nellesen Assistant City Attorney -7 "MIS CONSULTANT t �— By: Ambe kostellio Title: President / CEO SANTA ANA CITY COUNCIL Valerie Ani Benjamin Vazquez Thai Viet Phan Jessie Lopez Phil Be.. Johnalhan Ryan Hernandez Mayor Mayor Pm Tom, Ward 2 Wind Ward3 Ward Wards vamemummari, anaom bviivaazratsan i-ariaor Where santaana am -essieloosedihi nla-areard obanenarlsanta-anaom anhemandezesantaanaom DeNd Penabza Ward doenalozasasante-ana om CERTIFICATE OF LIABILITY INSURANCE DATE (MMn1D/YYYY) 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(les) 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 riahts to the certificate holder in lieu of such endorsementlsl- PRODUCER a �. �� Di $t Venbrook Insurance Services 16815 Von Karman Ave Suite 180 L. a 7i f E, L 0 FAX o ac No: certificates venbrook.com 949-652-3980 Irvine, CA Angie tJ 92606 MSU S AFFORDING COVERAGE NAIC; www.venbrook.cont CAo. OD80632 1 velers Casual Insurance Co of America 19046 INSURED Monument ROW I u elers Property Casual Co of America 25674 200 Spectrum Center, Acevedo o ri L of London 15642 Irvine CA 92618 11512 O I — COVERAGES CERTIFICATE NUMBER: 79779905 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 ADDL UBR POLICYNUMBER POLICY EFF MWDD POLICY EXP MIDD LIMITS A ✓ COMMERCIALGENERALLIABILITY ✓ ✓ 6807P4562802442 4/23/2024 4/23/2025 EACH OCCURRENCE $1000000 CLAIMS -MADE OCCUR PREMSES fEa ossenence $300000 MED EXP (Anyone person) $ 5 000 Deductible: none PERSONAL&ADV INJURY $1000000 ✓ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 GEN'L ✓ POLICY n JET LOG PRODUCTS -COMPIOP AGO $2 000,000 $ OTHER: A AUTOMOBILE LIABILITY 6807P4562802442 4/23/2024 4/23/2025 COMBINEDSINGLE LIMIT $1000000 BODILY INJURY (Per person) $ AUTO AUTOS SCHEDULED AUTOS OILY Al OS AANY BODILY INJURY(Peraccldent ) $ Peerr aciden DAMAGE$ WED AUTOS ONLY ✓ AUTOS ONLY B ,i UMBRELLALIAB ✓ OCCUR CUP5N8889392442 4/23/2024 4/23/2025 EACH OCCURRENCE $5000.000 AGGREGATE $5000,000 EXCESS LIAB CLAIMS -MADE DEC) I✓ RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OF CERIPMFLI WART EREXECU-11VE � XCL(Mandatory NIA ✓ UB2Y3528922442G 4/23/2024 4/23/2025 ,/ HfpTUTE ER E.L. EACH ACCIDENT $1000000 E.L. DISEASE -EA EMPLOYEE $1 In NH) It es, describe order DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT - $1 000 000 C Professional Liability (Claims Made MPL444730524 4/23/2024 4/23/2025 $2,000,000 Each Claim/ Aggregate Limit & Reported) Retention: $5,000 Each Claim DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more apace Is required) RE: The City of Santa Ana, its officers, employees, agents, and representatives are named as Additional Insured in respects General Liability per form CGD105 0494. Primary/Non-Contributory form CGT1000219, Waiver of Subrogation form CGD842 0219, WC040306 4-84 applies in favor of the Additional Insured when required by written Contract. 30 Day Notice of Cancellation per policy provisions. Subject to policy terms, Conditions and exclusions. CI Of Santa Ana SHOULD ANY OF THE ABOVE DIE City THE EXPIRATION DATE THEF Risk Management Division ACCORDANCE WITH THE POLICY 20 Civic Center Plaza, 4th Floor Santa Ana CA 92701 AUTHORnED REPRESENTATNE n POLICIES BE CANCELLED BEFORE I?EmEwED& APPROVED BY: A'ffU Aa'A4 Rhk Management Specialist ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 79779905 1 2029 GL, "D, UMB, an, PL Gabriela Covarrubias 1 4/30/2024 1:02:02 K4 (PDT) I Page I of B This certificate cancels and supersedes ALL previously issued certificates. Monument ROW e907P45e2802442 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION ll) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy. b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Includes Copyrighted Material from Insurance Services Office, In g isk Mafu &AppwvED E�. ® Ruk Management SpedMist 79779905 1 2024 GL, FIND, UM, WC, PL I Gabrlela Covarrubias 1 4/30/2024 1;02:02 PM (POT) I Page 2 of a This certificate cancels and supersedes ALL previously issued certificates. Monument ROW 6807134562802442 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. S. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date SECTION V — DEFINITIONS for audit and retrospective premiums is the date shown the due date on the bill. If the sum of 1 "Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or speck market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication: and as we may request. b. Regarding websites, only that part of a website that is about your goods, products or services 6. Representations for the purposes By accepting this policy, you agree: supporters is consid VEMs tudt> okcvm APruaveo8r. letr�neweDa , A+.p AaV410 `Ruk Management Speaarnt Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. 01 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 79779995 1 2024 GL, HNO, UVS, WC, PL I Gabriela Covarrubias 1 4/30/2024 1:02:02 PC (PDT) I Page 3 of 0 This certificate cancels and supersedes ALL previously issued certificates. Monument ROW COMMERCIAL GENERAL LIABILITY 8807P4582802442 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SMALL BUSINESSES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries B. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees And Co -Volunteer Workers PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Incidental Medical Malpractice E. Blanket Waiver Of Subrogation b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. Any of your subsidiaries, other than a partnership B. WHO IS AN INSURED — EMPLOYEES AND or joint venture, that is not shown as a Named VOLUNTEER WORKERS — BODILY INJURY Insured in the Declarations is a Named Insured TO CO -EMPLOYEES AND CO -VOLUNTEER if; WORKERS a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES 1. The following replaces the first sentence of Paragraph 3. of SECTION II — WHO IS AN INSURED: Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%. will qua, , CG D8 42 0219 © 2018 The Traveters Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with its pe �, KUlt mansgemnu utwim WAEWED & APPRavED EM `® Risk Management Spedaiist 79779905 1 2024 GL, HNG, DEB, WC, PL I Gabriela Covacrubias 1 4/30/2024 1-02:01 PP. (PDT) i Page 4 of 8 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY there is no other similar insurance available to that organization. 2. The following replaces the last sentence of Paragraph 3. of SECTION II — WHO IS AN INSURED: For the purposes of Paragraph 1. of Section 11 — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of 'occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) 'Incidental medical services' by any of your "employees' who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services' by any of your "employees' or "volunteer workers', other than an employed or volunteer doctor. Any such "employees' or "volunteer workers' providing or failing to provide first aid or "Good Samaritan services' during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees' for "bodily injury" that arises out of providing or failing to provide "incidental medical services' to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. E. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8.. Transfer Of Rights Of Recovery Page 2 of 3 ©2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permissio( 18ak ManagomnadDi"isian . RwEwED 6 APPROVm Br. Aju Auerda O� Risk Management Speaaist 01 79779905 1 2024 GL, NNO, UM, WC, FL I Gabriela Covarrabias 1 4/30/2024 1:D2:02 PM (PDT) I Page 5 cf 3 This certificate cancels and supersedes ALL previously issued certificates, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: COMMERCIAL GENERAL LIABILITY a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed: subsequent to the execution of the contract or agreement. c EWED ugemnttDivLslwr AEVIEWE�A&APPRpOpV®.BfY�: R� fi,4440 RNIEW Risk Management Spediist CG D8 42 02 19 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office . Inc., with its permiss 5.. 79779905 1 2024 GL, HNG, 0a6, WC, PL . Gabriel. ' arrubias 1 4/30/2024 1:62:02 Pa (PDT) I Page b o£ 6 This certificate cancels and supersedes ALL previously issued certificates. TRAVELERS/ J WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-2Y352892-24-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. „ RiskMotrgenentDM91on REmEWEDSAPPR fh: A-lu Azw4 ®' Risk Management Spedkist of DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE i OF 737793I6 2029 GL, HNG, UP , WC, PL Gabci^li - - 1 4/30/202J 1:L2:02 PC (PDT) I Pegs T of 3 This ceztificate cancels and supersedes ALL preiousl} issued certificates. Monument ROW POLICY NUMBER: 680-7P456280-24-42 ISSUE DATE: 02/14/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: PERSON OR ORGANIZATION: CITY OF SANTA ANA RISK MGMT DIVISION ADDRESS: 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. 30 30 B. If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such Schedule. We w address shown in the Sc number of days showr Renew (Nonrenewal) In effective date of nonrene ill mail such notice to the RA M�cgenmtDtulelan •% RtVIRVE�6APPROVaJBV: x� ® Risk Management Spedalist IL T4 00 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. 797-1"On 2024 GL, HNO, UN10, WC, PL Gabriels CY - ge s 1 4/30/2024 1:C2:02 rM IPDTI I PaE of 2 This certificate cancels and supersedes ALLpreviously issued certificates.