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Francine R. Digitally signed by Francine R.
<br />Villareal
<br />Villareal Date: 2021.08.10172926-07'00'
<br />BLUETEC-01 JPOMPIGNANO
<br />,d►coRo CERTIFICATE OF LIABILITY INSURANCE
<br />D07/22ATE /2021 Y)
<br />07/22/2021
<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 />The Fedeli Group
<br />6006 Rockside Road, Fifth Floor
<br />Independence, OH 44131
<br />CONTACT Janette Pompignano
<br />NAME:
<br />PHONE FAx
<br />(A/C, No, Ext): (216) 643-6651 (A/C, No):(216) 328-8081
<br />ADD"RIESS: JPompignano@thefedeligroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Valley Forge Insurance Company
<br />20508
<br />INSURED
<br />INSURER B : National Fire Insurance Company of Hartford
<br />20478
<br />INSURER C : Continental Insurance Company
<br />35289
<br />Blue Technologies Smart Solutions LLC
<br />INSURER D: Columbia Casualty Company
<br />31127
<br />6886 Grant Ave
<br />Cleveland, OH 44105
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />7014869669
<br />06/01/2021
<br />06/01/2022
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />700�QQQ
<br />$
<br />MED EXP (Any oneperson)
<br />$ 15,000
<br />PERSONAL & ADV INJURY
<br />$ 1 ,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY JECT LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />7014869672
<br />06/01/2021
<br />06/01/2022
<br />BODILY INJURY Per accident
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />C
<br />X
<br />UMBRELLA LAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />7014869686
<br />06/01/2021
<br />06/01/2022
<br />DED I X I RETENTION $ 10,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />7014859669
<br />05/01/2021
<br />05/01/2022
<br />PER X OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<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 />1,000,000
<br />$
<br />D
<br />Technology E&O
<br />652335893
<br />06/01/2021
<br />06/01/2022
<br />Third Party
<br />5,000,000
<br />D
<br />Cyber Liability
<br />652335893
<br />06/01/2021
<br />06/01/2022
<br />Limit
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as additional insureds as required by written contract. Policy is primary and
<br />non-contributory and includes 30 day notice of cancellation.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF,
<br />NOTICE WILL BE DELIVERED IN
<br />Risk Management Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
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<br />ACORD 25 (2016/03)
<br />©1988-2015 ACORD C
<br />;®.
<br />The ACORD name and logo are registered marks of ACORD
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<br />Risk Management Analyst
<br />
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