ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
09/05/2024
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
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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 endorsements).
Atto: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
CN117677530-GORD1-GAWUC-24- GORD INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: N/A NIA
The Gordian Group, Inc.
30 Patewood Drive, Bldg. 2, Suite 350 INSURER C: ACE Fire Underwriters Insurance Company 20702 Greenville, SC 29615
INSURER D:
INSURER E:
INSURER F:
COVERAGES SEA-004032727-03 REVISION NUMBER: 15
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 ADDL SUBR
LTR TYPE OF INSURANCE INSDWVD POLICY NUMBER LIMITS
A COMMERCIAL GENERAL LIABILITY HDO G27632348 07/01/2024 07/01/2025 EACH OCCURRENCE $ 3,000,000 DAMAGE TO RENTED 3,000,000
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
X Contractual Liability MED EXP (Any one person) 10,000 X Broad Form PD PERSONAL & ADV INJURY $ 3,000,000
6.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
PRO-
X POLICY LOC PRODUCTS - COMP/OP AGG es es 6,000,000
OTHER:
AUTOMOBILE LIABILITY ISA H08873318 07/01/2024 07/01/2025 COMBINED SINGLE LIMIT 5,000,000 (Ea accident)
X ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident)
AUTOS ONLY AUTOS
HIRED NON-OWNED ROPERTY DAMAG
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
RETENTIONS $
WORKERS COMPENSATION WLR C68933286 (AOS) 07/01/2024 07/01/2025 * | SEATUTE T
AND EMPLOYERS' LIABILITY
SCF C68933304 (Wl) 07/01/2024 07/01/2025 2,000,000
ANYPROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT
OFFICER/MEMBEREXCLUDED?
E.L. DISEASE - EA EMPLOYEE S 2,000,000
E.L. DISEASE - POLICY LIMITS 2,000,000
Professional Liability G73579569 004 07/01/2024 07/01/2025 Limit 3,000,000 Self-Insured Retention: $100,000
to the operations of the named insured General lily and auto liabill coverage videnced herein is considered primary and nanti do By:
MICHAEL E. GATES
CITY ATTORNEY
CERTIFICATE HOLDER CANCELLATIONCITY OF HUNTINGTON BEACH City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648
AUTHORIZED REPRESENTATIVE
March USA ACC
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN117677530
LOC#: Seattle
ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSURED
MARSH USA, LLO
POLICY NUMBER
CARRIER I NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Certificate of Liability Insurance Other - Cyber-Tech E&O:
Policy Number: MTP9035772-07
Carrier. Indian Harbor Insurance Company
Effective Date: 07/01/2024
Expiration Date: 07/01/2025
Limit: $10,000,000
SIR: $2,500,000
ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
11 POLICY NUMBER: HDO G27632348 Endorsement Number: 156
COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s): City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organizations) shown in the Schedule, but only Section III - Limits Of Insurance:
with respect to liability for "bodily injury" ", "property or "personal and advertising injury" If coverage provided to the additional insured is damage" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or
2. Available under the applicable limits of
2. In connection with your premises owned by or Insurance; rented to you. whichever is less.
However: This endorsement shall not increase the
applicable limits of Insurance.
1. There only apit dad to tend eradic sy
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 6 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS
Named Insured Endorsement Number
Fortive Corporation 26
Policy Symbo Policy Number Policy Period Effective Dale of Endorsement G27632348 07/01/2024 to 07/01/2025
ACE marian Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY COVERAGE
Schedule
Organization Additional Insured Endorsement
Any additional insured with whom you have agreed to provide such non-contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss.
(If no information is filled in, the schedule shall read: "All persons or entities added as additional insureds through an endorsement with the term "Additional Insured" in the title) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV.4.a:
If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Authorized Agent
LD-20287 (06/06) Page 1 of 1
7 ADDITIONAL INSURED -
DESIGNATED PERSONS OR ORGANIZATIONS
Named Insured Fortive Corporation Endorsoment Number
Policy Symbol Policy Number Effective Date of Endorsement H08873318 07/01/2024 TO 07/01/2025
Issued By (Name of Insurance Company)
ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequen to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
AUTO DEALERS COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
EXCESS BUSINESS AUTO COVERAGE FORM
Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.
A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations named in this endorsement. However, these persons or organizations are an "insured" only for "bodily injury" or "property damage" resulting from acts or omissions of:
1. You.
2. Any of your "employees" or agents.
3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents.
The persons or organizations named in this endorsement are not liable for payment of your premium.
Authorized Representative
DA-9U74c (03/16) Page 1 of 1