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<br />TE ACOI2o CERTIFICATE OF LIABILITY INSURANCE by Angie D 0712v410lY2022
<br />a7122
<br />Ai
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS TI � THCERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL E C V_a FORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TrIE �`�r12ER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. A i
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must iUWDIT,ONAL IN Uj2Etprovlsians 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 endorsements .
<br />PRODUCER 445-201-1625 CONTACT Paul J. Lucci
<br />Poole Professional B&B of MA PHONE 445-201-1625 FAX
<br />107 Audubon Rd, #2, Ste 305 arc, No Exe : we No
<br />Wakefield, MA018S0 EMAIL ,paul.lucci@bbrown,com
<br />Paul J. Lucci
<br />R Design Inc.
<br />3 Chestnut St., Suite 909
<br />iladelphia, PA 19107
<br />Travelers Indemnity Co of CT Z51it32
<br />Travelers Indomnity Co. 25658
<br />Travelers Prop Casualty Co Am 25674
<br />XL Specialty Insurance Company 37885
<br />r-nl1c0nrzr4Z rrGOTlor-ATc K1I111nel: IM-0- octir111clnkl r,ulnaQeo.
<br />THIS tS 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 />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY EXf
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />680-2J979064-22-47
<br />07111/2022
<br />07/11/2023
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAMAGE TO RENTED
<br />currai
<br />S 1,000,000
<br />MED FXP (AnV oneperson)10,000
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />GEN'L AGGREGATE LIMIT AP PLIES PER:
<br />PE LOC
<br />POLICY �X JCT
<br />OTHER:
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,a00
<br />S
<br />IB
<br />AUTOMOBILE
<br />Ix
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY X A�TO ONLY
<br />BA-9R272273-22-47-G
<br />07/11/2022
<br />0711112023
<br />COMBINED SINGLE UMIT
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />BODILY INJURY Per accident
<br />$
<br />Pe0accitlen�AMAGE
<br />$
<br />C
<br />X
<br />UMBRELLALIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />CUP-673GY412-22-47
<br />07/11/2022
<br />07111/2023
<br />EACH OCCURRENCE
<br />S 5,000,000
<br />AGGREGATE
<br />S 5,000,000
<br />DIED I I RETENTION $
<br />C
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETOWPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in Ni
<br />It yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N f A
<br />UB-71C189676-22-47-G
<br />0711112022
<br />07/11/2023
<br />X PER OTH-
<br />JTF
<br />F.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />E.L. DISEASE - POLICY LIMrf
<br />5 1,000,000
<br />D
<br />Professional
<br />Liability
<br />DPR9996109
<br />07111/2022
<br />07/11/2023
<br />I a Claim
<br />Aggregate
<br />4,000,000
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES {ACORD 101, Addiflonal Remarks Schedule, may be attached If more space is required)
<br />RE: City of Santa Ana Agreement # A-2021-060.
<br />See next page for description
<br />City of Santa Ana
<br />Risk Management
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702-198
<br />ACORD 25 (201 &1
<br />SANTA-3
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />i; AUTHORIZED REPRESENTATIVE
<br />RIA Matogement Division
<br />�. REvii &APPROVED BY:
<br />O 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORDD Risk Manage-ment5pedalisl
<br />
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