|
CITEC -1 OP ID: JI
<br />CERTIFICATE OF LIABILITY INSURANCE
<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 />DATE
<br />09 /25 /2015 Y)
<br />09/25/2015
<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
<br />Brown & Brown of Florida, Inc.
<br />Building 100, Suite 100
<br />10151 Deenwood Park Blvd
<br />Jacksonville, FL 32256
<br />NAME: CT House Accounts
<br />PHONE FAX
<br />Arc No E,t:904- 565 -1952 INC, No: 904 -565 -2440
<br />E -MAIL
<br />ADDRESS:
<br />GENERAL LIABILITY
<br />House Accounts
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />INSURER A: Travelers Property Casualty Co
<br />36161
<br />$ 1,000,000
<br />INSURED Cl Technologies, Inc.
<br />INSURER B: Standard Fire Insurance Co.
<br />19070
<br />PO Box 551700
<br />Jacksonville, FL 32255 -1700
<br />INSURER C: The Travelers Indem Co of CT
<br />25682
<br />10/0112016
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 250,000
<br />INSURER D:
<br />CLAIMS -MADE ®OCCUR
<br />INSURER E:
<br />INSURER F:
<br />MED EXP(Any one person)
<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 />NSR
<br />LTR
<br />TYPE OFINSURANCE
<br />ADDL
<br />SUER
<br />POLICYNUMBER
<br />MMIDDIVVVY
<br />MMLDDIVVVV
<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 />X
<br />ZLP -51 M42335
<br />1010112015
<br />10/0112016
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 250,000
<br />CLAIMS -MADE ®OCCUR
<br />MED EXP(Any one person)
<br />$ 10,00
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,00
<br />X POLICY PRO LOG
<br />Emp Ben.
<br />$ 1m /3magg
<br />AUTOMOBILE LIABILITY
<br />_
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />C
<br />ANY AUTO
<br />BA- 5612R914
<br />10/01/2015
<br />10/01/2016
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DENT)
<br />$
<br />X HIRED AUTOS X AULOSWNED
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,00
<br />X
<br />AGGREGATE
<br />$ 2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />ZUP- 71M40939
<br />10/01/2015
<br />10101/2016
<br />LEO X I RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICER /MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />NIA
<br />UB-7649C381
<br />10/01/2015
<br />10/01/2016
<br />X WC STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />EL DISEASE EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />•
<br />Professional Liab
<br />ZPL- 13TIO732
<br />10/01/2015
<br />10/01/2016
<br />Agg /Claim 1,000,00
<br />•
<br />Errors & Omissions
<br />ZLP -51 M42336
<br />10/01/2015
<br />1010112016
<br />Claim /Agg lmil /2mil
<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 />�CJV � \oow
<br />. V -Q
<br />cJOnjS u.2h -"\
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) 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 />Santa Ana CA 92702
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|