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CITEC-1 OP ID: BA
<br />,a►�co�Ezo 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 104(MM/2019Y)
<br />01/04/2019
<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(les) 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 Deerwood Park Blvd
<br />Jacksonville, FL 32256
<br />NOAMNEHCT House Accounts
<br />PHONE g04-565-1952 FAX
<br />ac No E#: Ac Ne: 904-565-2440
<br />E -MAL
<br />ADDRESS:
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />House Accounts
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURER A: Travelers Property Casualty Co 36161
<br />10101/2018
<br />INSURED Cl Technologies, Inc.
<br />PO Box 534
<br />Townsend, MA 01469
<br />INSURER B: Standard Fire Insurance Co. 19070
<br />INSURER C: The Trevelers Indem Co of CT 25662
<br />INSURER D :
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUB
<br />MO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMODNYYY)
<br />POLICY EXP
<br />(MNUDDfYYYYI
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />Y
<br />ZLP-51 M42335
<br />10101/2018
<br />10/0112019
<br />EACH OCCURRENCE $ 1,000,00
<br />PREMISES Ea occurrence $ 300,00
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL &ADV INJURY $ 1,000,00
<br />GEN'L AGGREGATE LIMITAPPLIES PER:
<br />POLICY ] JECT PRC- [:]LOC
<br />GENERAL AGGREGATE $ 2,000,00
<br />PRODUCTS - COMP/OP AGO $ 2,000,00
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />CEe accOMBINED SINGLE LIMB
<br />ident $ 1,000,00
<br />CIx
<br />ANYAUTO
<br />BA -561211914
<br />10101/2018
<br />10/01/2019
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />UMBRELLA LIM
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 2,000,00
<br />A
<br />X
<br />EXCESS LIM
<br />CLAIMS -MADE
<br />CUP-OL613731
<br />10/01/2018
<br />10/01/2019
<br />AGGREGATE $ 2,000,00
<br />DED I X I RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERTUASILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS beb
<br />NIA
<br />UB -5J316796
<br />10/01/2018
<br />10/01/2019
<br />X I PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E DISEASE - EA EMPLOYEE $ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />A
<br />Prof. Liability
<br />ZPL-13T10732
<br />10/01/2018
<br />10101/2019
<br />Agg/Occ 2,000,0011
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U 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 />I�Cv%+ Y�� PmrS —OutzAv
<br />City of Santa Ana, its offic-
<br />ers, employees, agents and
<br />volunteers
<br />60 Civic Center Plaza
<br />ACORD 25 (2014/01)
<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 />G
<br />©1988-2014 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />All rights reserved
<br />
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