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CITEC -1 OP ID: SH
<br />Aco.rro° CERTIFICATE OF LIABILITY INSURANCE
<br />� --"'�-
<br />DAT04104OIYYYY)
<br />04104113
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER Phone: 904- 565 -1952
<br />Brown &Brown of Florida, Inc.
<br />Building 100, Suite 100 Fax: 904. 565 -2440
<br />10151 Deerwood Park Blvd
<br />Jacksonville, FL 32256
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />AIC No Ezt : AIC, No
<br />E -MAIL
<br />ADDRESS:
<br />GENERAL LIABILITY
<br />House Accounts
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICN
<br />INSURER A: St. Paul Fire 8r Marine Ins Co.
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />INSURED Cl Technologies, Inc.
<br />INSURER B: Phoenix Insurance Company
<br />A
<br />PO Box 551700
<br />St Augustine, FL 32255.1700
<br />INSURER C: The Travelers Indemnity Co
<br />25658
<br />ZLP- 11545541
<br />10101112
<br />�1 ]'�
<br />l,J
<br />Al, ,/3-030
<br />INSURER D:
<br />$ 10,000
<br />INSURER E:
<br />$ 1,000,000
<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 />R
<br />TYPE OF INSURANCE
<br />AO
<br />POLICY NUMBER
<br />POLICY IIYEYry
<br />MMIDYl1'EYW
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES Ea occurrence
<br />$ 250,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />ZLP- 11545541
<br />10101112
<br />10101/13
<br />MED EXP Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X
<br />Blanket Al
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />POLICY PRO- CDC
<br />JECT
<br />Emp Ben.
<br />$ 1M /3M Agg
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY person)
<br />5
<br />C
<br />ANY AUTO
<br />BA- 5612R914
<br />10/01/12
<br />10/01/13
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIREDAUTOS X NON -OWNEC
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ZLP- 11S45541
<br />10/01112
<br />10101113
<br />DED X RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N I A
<br />UB- 7549C381
<br />BLANKET WOS
<br />10/01/12
<br />10/01113
<br />X I TWO STATU- OTH-
<br />TORY LIM TS ER
<br />E.L. EACH ACCIDENT
<br />S 1,000,000
<br />E.L, DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe untle,
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000,000
<br />A
<br />Errors & Omissions
<br />10/01/12
<br />10101113
<br />Ea. Claim 1,000,000
<br />Retro: 10 101/2005
<br />77�
<br />Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, employees, agents and volunteers are
<br />listed as additional insured when required by written contract.
<br />13PROVED AS TO FORM
<br />r-�
<br />Capra A. Rossini
<br />CERTIFICATE HOLDER ASS1STant Ulty At'tortle.VCANCELLATION
<br />ACORD 25 (2010105)
<br />© 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana, Its offic-
<br />ers, employees, agents and
<br />—
<br />AUTHORIZED REPRESENTATIVE
<br />volunteers
<br />60 Civic Center Plaza
<br />Santa Ana CA 92702
<br />ACORD 25 (2010105)
<br />© 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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