|
&( CW4
<br />V' CAVIiA 11(5
<br />MW
<br />CERTIFICATE
<br />OF LIABILITY INSURANCE
<br />OATS{Mo'lDoT Y)
<br />0 8/2 012 0 1M -D 0.
<br />R OF � �J,,Q, �j Q�� R$�J
<br />ATE IS ISSUED AS A EOR
<br />IO,�,IP6$N2;.. fD E=TIHE ABY
<br />CEIRTFCATECDOES NOT AFFIRMATIVELY NEGATII(
<br />}�. XTE �!'ER COVERAGE AFFORDED THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the csrtlfioale alder is an ADDITIONAL
<br />the terms and conditions of the policy, certain policies m
<br />U E e. a i (d9) dl H IM endorsed. It SUBROGATION IS WAIVED, subject to
<br />C1E,?n jn&f0oj'3 ei$( *�atement on this certificate dace not confer rights to the
<br />certificate holder in lieu of such endorsement(a).
<br />LIMITS
<br />PRODUCER
<br />AOM Risk Services Northeast, Inc.
<br />Boston MA Office
<br />CONTACT
<br />E
<br />NAMONE
<br />_
<br />(AIC, No, Ext: 1866) 283.7122 AC.11 : (800) 363-0105
<br />&MAIL
<br />ADDRESS;
<br />One Federal Street
<br />Boston MA 02110 USA
<br />INSUREIR(S) AFFORDING COVERAGE NAIC4
<br />$2, GOO, 500
<br />INSURED
<br />INSURER A: Travelers Property Cas CO Of America 25674
<br />IDEXX Laboratories, Inc.
<br />one IDEXX Drive---
<br />Westbrook ME 04092-2041 USA
<br />INSURER B; Charter Oak Fire Ins cc 25615
<br />INSURER O: Federal insurance Tante Company 20281
<br />INSURER D; NOetiC Specialty Insurance c0 17400
<br />p �,
<br />1. )I+
<br />MED EXP (Any one person)) 810,000
<br />INSURER L--:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570054941445 REVISION'NUMBER; '
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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, Limits shown are as roomerIted
<br />LTRINUR
<br />TYPE OF INSURANCE
<br />ADID[
<br />D
<br />POST[
<br />MD
<br />POLICYNUMBER
<br />MMIDOIYYYY
<br />M DD
<br />LIMITS
<br />X COMMERCIAL OENEKALLIABILITYons/io/ZolEACHCCCURRENCE
<br />$2, GOO, 500
<br />pREMI'as Ea agNto cu re ce ILD 52,0001000
<br />CLAIM&MAGE [—X] OCCUR
<br />MED EXP (Any one person)) 810,000
<br />0
<br />L�
<br />PERSONAL A ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY L._..1 ECT �X Lpp
<br />OTHER:
<br />GENERALAGOREGATE $2,000,000
<br />PRODUCTS ICOMPIOP AGO Excluded
<br />C
<br />AUTOMOBILE LIABILITY
<br />73580790
<br />J"1/2014
<br />06/30 2015
<br />COMEINED SINGLE LIMIT $1,000,000
<br />Ea etc dent
<br />4i
<br />BODILY INJURY (Par person)
<br />X ANYAOTO
<br />Z
<br />BODILY INJURY (Par acpldenn
<br />ALLOWNED SCHEDULED
<br />W
<br />AUTOS AUTOS
<br />HIRED AUTOS NON.OWNEO
<br />AUTOS
<br />L
<br />PROPERTY DAMAGE
<br />Peraccldenl
<br />W
<br />O
<br />% UMBRELLA LIAB
<br />OCCUR
<br />890079
<br />06/30/2014
<br />06/30/2015
<br />EACH OCCURRENCE 10,000,000
<br />to
<br />AGGREGATE $10,000,000
<br />EXCESS LIAB
<br />H
<br />CLAIMS -MADE
<br />qEq I IRPTENTION
<br />I
<br />B
<br />A
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE VIN
<br />OFFICERIMEMDCR EXOLUDIiW
<br />(Mandatory In NH)
<br />NIA
<br />TC20UBIOID10 6
<br />WC BIQI
<br />TR3U8101D10181A
<br />WC (MA,WI)
<br />1 O1
<br />01/01/2014
<br />U 1 2015
<br />01./01/2015
<br />ppTATUqq
<br />X TE GTI
<br />G
<br />EL, EACH ACCIDENT $1,000,000
<br />E1. DISEASE -EA EMPLOYEE 51,000,000
<br />pYesrtsserlbo under
<br />OGSdRINION OF OPERATIONS below
<br />-
<br />E,L. DISEABE80LICY LIMIT $1,0 00,000_....,.
<br />D
<br />Products Lien
<br />N14ME3 00003
<br />SIR applies per policy terns
<br />0-6/73-07-2014
<br />& condi
<br />06 0 2015
<br />ions
<br />Aggregate $10,0 0,000
<br />Per occurrence $10,000,000
<br />`-'-'
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be abashed If more space is required)
<br />The city of Santa Ana and their respective officers, employees agents, volunteers and representatives are included as
<br />Additional Insured on the General Liability policy, but only with respect to liability caused by the acts or omissions of IDEXX
<br />Laboratories Inc. in the performance ongoing operations of or in connection with premises awned or rented by IDEXX Laboratories
<br />Inc. Coverage afforded by the General Liability policy shall be Primary and Non-contributory for the certificate Holder With
<br />respect to work performed by IDFXX Laboratories Inc.
<br />sD,,_•
<br />y
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />c!
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE W17H THE
<br />POLICY PROVISIONS.
<br />The City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />20 civic Center Plaza - M23
<br />Santa Ana c0. 92701 USA a iso i2¢rexard e//wtGuixrlL�✓oda
<br />r#r-
<br />(01988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|