|
Cam: -ormw
<br />OP ID: LP
<br />�.. CERTIFICATE OF LIABILITY INSURANCE
<br />(MM/DD/YYYY)
<br />03/24/2017
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER 215.564.6970
<br />CONTA
<br />NAME:CT pawl Lucci
<br />PHONE 215-564-6970 FAX 215.564-6975
<br />(A/C, No, Ext): (A/C, No):
<br />Wortley/Poole Profession al,Ltd
<br />1 Penn Center
<br />1617 JFK Boulevard, Suite 880
<br />Philadelphia, PA 19103
<br />Paul J. Lucci
<br />E-MAIL plucci@wortleypoole.com
<br />ADDRESS_
<br />_—
<br />'..
<br />-- ----. INSURER(S)-AFFORDING COVERAGE NAIC #
<br />INSURER A: Charter Oak Fire Ins. Co. 25615
<br />INSURED CLR Design Inc
<br />833 Chestnut St., Suite 1000
<br />Philadelphia, PA 19107
<br />INSURER B ; Travelers Property Casualty Co ',. 25674
<br />INSURER C ; Travelers Indemnity Co. 25658
<br />—
<br />INSURER D : Travelers Casualty and Surety 19038
<br />-----------------------....--------------
<br />INSURER E : XL Specialty Insurance Company 37885
<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 />-_LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />.IN_SD
<br />SUBR
<br />WVD
<br />POLICY NUMBER --
<br />POLICY EFF
<br />(�ry)jpD1�Y�Yj.
<br />POLICY EXP
<br />MM/DD/YYYYI
<br />LIMITS —
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />...... __.
<br />X
<br />680-2727LL060
<br />07/11/2016
<br />07/11/2017
<br />,EACH —
<br />DAMAGE TO RENTED
<br />pR._E.MISE$ (Ea occurrence ).-
<br />-.._ .--
<br />$ 1,000,000
<br />- ----..
<br />_—_
<br />(Any one person)
<br />.._...._ .-.-.
<br />$ 10,000
<br />_MED_EXP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GE_N'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ®PIRCJ LOC
<br />_
<br />PRODUCTS-COMP/OPAGG
<br />S 2,000,000
<br />..--
<br />-OTHER:
<br />—_.---.....................---- -
<br />$
<br />B
<br />AUTOMOBILE LIABILITY
<br />-
<br />-------....---.......-------...-...--------
<br />COMBINED SINGLE LIMIT
<br />(Ea.accident)_.......------- .............. ...�
<br />1,000,000
<br />----.._......_._
<br />L. ANY AUTO
<br />BA-27281_15A
<br />07/11/2016
<br />07/11/2017
<br />BODILY INJURY CPerperson)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X HIRED X NON -OWNED
<br />PROPERTY DAMAGE
<br />accident)
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />.._(Per
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP-6736Y412
<br />07/11/2016
<br />07/11/2017
<br />AGGREGATE____
<br />$ 5,000,000
<br />DED I RETENTION$
<br />___
<br />D
<br />WORKERS COMPENSATION
<br />ll PER r
<br />X_L_STATUTE_ �R_„____
<br />--
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />UB7302Y24A
<br />ET
<br />_ _
<br />ANYPROPRIMB R/PXCLUD /EXECUTIVE
<br />07111/2016
<br />07/11/2017
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEE
<br />_$_ _ ------
<br />1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />_$
<br />1,000,000
<br />$___
<br />E Professional DPR9807064 07111/2016 07/11/2017 Ea Claim 2,000,000
<br />Liability Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Agreement # A-2016377
<br />i�k�FbC,iBF{1Ht' IwiI"Nl C,i_ RE1)'IA(PG0 " F q)
<br />SANTA-3
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702-1988
<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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|