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CITEC -1 OP ID: JA CERTIFICATE OF LIABILITY INSURANCE /D0/ 1 D TYPE OFINSURANCE 09 /11 09/11/20113 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ('�ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOW. TTHIS CERTIFICATE FOF INSURANCE DOES NOTLC0019T �/j�EC(Wq&- 53ETWEEN COVERAGE THE ISSUING THE AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INS tF)epoc(�s} {nut a endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may re n nd ilteht5 ment on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). -` ['41 U f n PRODUCER Phone: 904 -565 -1952 Brown & Brown of Florida, Inc. Fax:904- 565 -2440 Building 100, Suite rk 10151 Deerwood Park Blvd Jacksonville, 32256 p/3 - 03 b CONTACT NAME: PRONE FAX Nc o Ent: JC No: E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # HOUSe AGCOUOts /I/- oe is INSURER A: St. Paul Fire & Marine Ins Co. 10/0112013 INSURED CI Technologies, Inc. Box551700 St St Augustine, FL 32255 -1700 INSURER B: Phoenix Insurance Com an $ 1,000,00 INSURER C: The TravelersIndemni Co 25658 INSURER D : $ 10,00 PERSONAL& ADV INJURY INSURER E : INSURER F: 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 OFINSURANCE ADDL SUB POLICY NUMBER MM /D�V /YYVY O-LICYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR X ZLP- 11S45541 -13 -15 10/0112013 10/01/2014 EACH OCCURRENCE $ 1,000,00 OgMAG RE ED PREMISES Ea occurrence $ 260,00 MED EXP (Any one person) $ 10,00 PERSONAL& ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: JEr POLICY PRO- LOC PRODUCTS- COMP /OP AGG $ 2,000,00 Emp Ben. $ 1m /3mag C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED BA- 5612R914- 13 -TEC 10101/2013 10/01/2014 Ee sBBIc ED SINGLE LIMIT $ 1,000,00 BODILY INJURY(Per person) $ BODILY INJURY(Peraccident) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED PROPER YDAMAGE Peraccident $ A UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE ZLP- 11S45541 -13 -15 10/01/2013 10/0112014 EACH OCCURRENCE $ 2,000,00 J( AGGREGATE $ 2,000,00 DED X RETENTION$ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y/N OFFICER /MEMBER EXCLUDED? [] N/A HFUB- 7549C38 -1 -12 10/01/2013 10/0112014 WC STATU- OTH- X Y LIMI E EL. EACHACCIDENT $ 1,000,00 [Mandatory'"° °r If yes, describe under E.L. DISEASE -EA EMPLOYEE$ t,000,UU E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, its officers, employees, agents and volunteers are listed as additional insured when required by written contract. AP'PROVED T® FORM Laura A. Rossini tt me City of Santa Ana, its offic- ers, employees, agents and volunteers 60 Civic Center Plaza ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v 1'68 -ZULU AUOKU GUKPUKA I ION. All rights reserved. The ACORD name and logo are registered marks of ACORD