|
OP ID: LP
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D08/20/201ATE YY)
<br />08/20/2018
<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 />Wortley/Poole Professional, Ltd
<br />1 Penn Center
<br />1617 JFK Boulevard, Suite 880
<br />Philadelphia, PA 19103
<br />Paul J. Lucci
<br />CONTACT
<br />Paul Lucci
<br />P ONE FAX
<br />Alc No Eat : 215-564-6971 A/C No : 215-564-6975
<br />EMAIL ADDRESS: plucci@wortleypoole.com
<br />wortle oole.com
<br />PRODUCER
<br />CUSTOMER ID #: CLRDE-1
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED CLR Design, Inc
<br />INSURER A: Charter Oak Fire ins. Co. :25615
<br />833 Chestnut Street,Suite 1000
<br />Philadelphia, PA 19107
<br />INSURER B :Travelers Indemnity Co. '.2565$
<br />INSURER C :Travelers Indemnity Co.
<br />125674
<br />INSURER D : XL Specialty Insurance Company
<br />37885
<br />INSURER E :
<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 LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER WVD
<br />POLICY NUMBER
<br />MOL pY EFF
<br />Mn IIDD EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />DAMAGE TO RENTE
<br />PREMISES Ea occurrence
<br />$_ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />Y
<br />680-2J979064
<br />07/11/2018
<br />07/11/2019
<br />MED EXP (Any one person)
<br />$ 10,00
<br />PERSONAL S ADV INJURY
<br />$ 1,000,00
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,00
<br />POLICY PRO jECTLOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />--'—'—
<br />$ 1,000,00
<br />' ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />B
<br />SCHEDULED AUTOS
<br />X i HIRED AUTOS
<br />BA-272BL15A
<br />07/11/2018
<br />07/11/2019
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />$
<br />X NON -OWNED AUTOS
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP-6736Y412
<br />07/11/2018
<br />07/11/2019
<br />DEDUCTIBLE
<br />$
<br />$
<br />.RETENTION $
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)If
<br />N / A
<br />UB7K189676
<br />07/11/2018
<br />07/11/2019
<br />X WCSTATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE$
<br />1,000,00
<br />yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $ 1,000,00
<br />sional
<br />DPR9928636
<br />07/11/2018
<br />07/11/2019
<br />Ea Claim 4,000,y
<br />!Z4
<br />Ann Agg 4,000,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: Agreement # A-2016-377 City of Santa Ana, its officers, employees
<br />agents and representatives are named as additional insured as respecis
<br />general liability for services provided by the named insured. Coverage is
<br />primary and non-contributory.
<br />30 days notice of cancellation applies. REVIEWED BY: EUNICE HEREDIA (PG ( OF �, )
<br />CERTIFICATE HOLDER
<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 />@ 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|