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LIBRA-4 OP VLF: CA
<br />ACC7�'2i'�. CERTIFICATE OF LIABILITY INSURANCE DATE 5/2015Y)
<br />'�---� 06126/2015
<br />THUS 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 I'NSURER(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.. CONTACT
<br />NAME: John A. Latimer, IV
<br />Keller Stonebraker Ins. H) G
<br />1120 C Professional Court ca"coNr o, ek301-733-2530
<br />i FAX 301-791-1478
<br />P.O. Box 609 E-MAIL
<br />Hagerstown, MD 21741-0609 ADORES$:
<br />Mike Cumberland INSURER(SIAFFORDING COVERAGE NAIC p
<br />INSURED
<br />Carl Corporation and
<br />Tech -Logic Corporation, ETAL
<br />1 Research Park
<br />Inwood, WV 25428-9733
<br />INSURERA:Great Northern Insurance Col. 20303
<br />INSURER B : Federal Insurance Co. _ 20281
<br />INSURERc,Chubb Indemnity _... ........ ... ......
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER!
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
<br />CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE ADDL SUER
<br />LTR IN" WVO POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MM/DDIYYYY MMIDDIYYYY LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />',, EACH OCCURRENCE S
<br />1,000,000'
<br />CLAIMS -MADE X... OCCUR x 360311761
<br />OHMAGE TO RENTED
<br />05/2612015 0512612016
<br />PREMISES (Ea occurrence) 5
<br />....
<br />1,000,000
<br />MED I (Any one person) S _...
<br />10,000
<br />PERSONAL & ADV INJURY S
<br />1,000,000
<br />GLEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE S
<br />2,000,000
<br />POLICY x PRO-
<br />JECT LOG
<br />PRODUCTS - COMP'IOPAGG S
<br />2,000,000
<br />OTHER
<br />$
<br />AUTOMOBILE LIABILITY
<br />_
<br />COMBINED SINGLE LIMIT $
<br />(Ea accident) _....
<br />,. .
<br />1,000,000
<br />A X ANY AUTO 73588935
<br />05126/2015 05126/2016 BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) 5
<br />NON-CWNX
<br />AMAGE S
<br />__ HIRED AUTOS _x_, AUTOS
<br />(Per�accdent)RTY
<br />(Per ....... ...
<br />.........
<br />S
<br />X UMBRELLA LAB '.., X OCCUR
<br />EACH OCCURRENCE. S
<br />6,000,000
<br />13 EXCESS LAB CLAIMS -MADE 79898652
<br />0512612015 0512612016 AGGREGATE S
<br />6,000,000
<br />...DED x... RETENTIONS 0,
<br />__. _... S
<br />WORKERS COMPENSATION
<br />x PER OTH:-.
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY Y
<br />C ANY PROPRIFTORrPARTNERIEXECUTIVE � 71751556
<br />05/2612015 0512612016 F L EACH ACCIDENT $
<br />1,000,000
<br />OFFICERIMEMBER EXCLUDED7 I.N.' .J N IA
<br />(Mandatary In NH)
<br />E L. DISEASE - EA EMPLOYEE $ .....
<br />1,000,000
<br />If yes, describe under
<br />ES RI OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT S
<br />1,000,000
<br />A Professional Liab 36031761
<br />0512612015 0512612016 ClairnlAgg
<br />5,000,000
<br />Claims Made
<br />Retentionr.
<br />25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requlred,� �,,W
<br />City of Santa Ana, It's Officers, emplo ees, agents volunteers and (�z`
<br />representatives are additional insured as indicate+, when required by
<br />writtenggcontraact
<br />attached form 80-02-2367.Covera
<br />`
<br />per
<br />is non-contributory.
<br />**
<br />CORRECTEDmary,
<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTAAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza. M-30
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />4r
<br />1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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