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CITEC -1 OP ID: JO
<br />'`'il °RO9 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 08 /0 512 01 VV)
<br />08/0512014
<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 />CONTACT
<br />NAME:
<br />Brown & Brown it Florida, Inc. Fax: 904. 565.2440
<br />Building 100, Suite 100
<br />10151 Deemood Park Blvd
<br />Jacksonville, FL 32256
<br />PHONE FAX
<br />AIC No Ext: AIC No:
<br />EMAIL
<br />ADDRESS:
<br />Josh Blacksmith
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC al
<br />INSURER A: St. Paul Fire & Marine Ins Co.
<br />24767
<br />A
<br />INSURED Cl Technologies, Inc.
<br />INSURER B:Standard Fire Insurance Co.
<br />19070
<br />PO Box 551700
<br />St Augustine, FL 32255 -1700
<br />INSURERC:The Travelers Indent Co of CT
<br />25682
<br />INSURER D: Travelers Property Casualty Co
<br />36161
<br />INSURER E:
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<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 />LTft
<br />TYPE OF INSURANCE
<br />JU&MD
<br />POLICY NUMBER
<br />POLICY
<br />Y
<br />MMDOVVV
<br />MMIDDIVVVV
<br />LIMITS
<br />Santa Ana CA 92702
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS,MADE 1K OCCUR
<br />X
<br />ZLP -11 S45541 -14 -15
<br />10/0112014
<br />10/01/2015
<br />DAMAGE TO RENT
<br />PREMISES Ea occurrence
<br />$ 260,000
<br />MED EXP (Any one person)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,000
<br />X Poucv PRO' LOC
<br />Emp Ben.
<br />$ 1m /3magg
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />C
<br />ANY AUTO
<br />BA- 5612R914.14-TEC
<br />10/01/2014
<br />10/01/2015
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />X
<br />AGGREGATE
<br />$ 2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ZLP- 11S45541 -14 -15
<br />1010112014
<br />10101/2015
<br />LED X I RETENTION$ 10,000
<br />$
<br />1
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNER /EXECUTIVE YIN
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />HNUB- 7549C38 -1 -14
<br />10/01/2014
<br />10/01/2015
<br />X ORVTATU- OTH-
<br />E,L, EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DISCRIPT ION OF UPEHA I'IUNB below
<br />E.L. DISEASE-POLICY LIMIT
<br />$ 1,Ovv,000
<br />D
<br />Professional Liabi
<br />ZPL- 13T10732 -14 -15
<br />10/0112014
<br />10/0112015
<br />Agg /Claim 1,000,000
<br />A
<br />Errors & Omissions
<br />ZLP - 11 5 4 5 541 -1 4.15
<br />10/01/2014
<br />1010112015
<br />Claim /Agg 1mil /2mil
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACERB 101, Additional Remarks Schedule, If more space is required)
<br />The City of Santa Ana, its officers, employees, agents and volunteers are P�j,,-�ar
<br />listed as additional insured when required by written contract. V.04C('A at)
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<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 />volunteers
<br />60 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />__7
<br />Santa Ana CA 92702
<br />ACORD 25 (2010/05)
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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