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CITEC-1 OP ID: BA
<br />14`4110.o,Ro CERTIFICATE OF LIABILITY INSURANCE
<br />TE
<br />DA10/20/20/2017
<br />1 012 01 7
<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 Deerwood Park Blvd
<br />Jacksonville, FL 32256
<br />CONTACT House Accounts
<br />NAME:
<br />A/c Ne EXe:904-565-1952 ac No: 904-565-2440
<br />EMAIL
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE NAICN
<br />House Accounts
<br />INSURER A: Travelers Property Casualty Co 36161
<br />INSURED Cl Technologies, Inc.
<br />PO Box 534
<br />INSURER B: Standard Fire Insurance Co. 19070
<br />INSURER C : The Travels- Indem Co of CT 25682
<br />Townsend, MA 01469
<br />INSURERD:
<br />X
<br />INSURER E:
<br />ZLP-51M42335
<br />10/0112017
<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 />rypE OF INSURANCE
<br />DOL
<br />UB
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,06
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE L ] OCCUR
<br />X
<br />ZLP-51M42335
<br />10/0112017
<br />10/01/2018
<br />PREMISES Eacccunence $ 366,66
<br />MED EXP (Anyone person) $ 10,06
<br />PERSONAL &ADV INJURY $ 1,000,00
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMITJECT A
<br />PRODUCTS-COMP/OP AGO $ 2,000,06
<br />LPER:
<br />RD O
<br />POLICY PRD_
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT 1,666,66
<br />Ea accident $
<br />BODILY INJURY (Per person) $
<br />C
<br />ANY AUTO
<br />BA -5612R914
<br />10/01/2017
<br />10/01/2018
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident $
<br />( )
<br />HIREDAUTOS X NON -OWNED
<br />AUTOS
<br />X
<br />PROPERTY DAMAGE $
<br />PER ACCIDENT
<br />UMBRELLALIABX
<br />OCCUR
<br />EACH OCCURRENCE $ 2,006,00
<br />X
<br />AGGREGATE $ 2,000,00
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />ZUP-71M40939
<br />1010112017
<br />10/0112018
<br />DED X RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVEUB-5J316796
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />10/0112017
<br />10101/2018
<br />X WC STATU- OTH-
<br />CRYIMT ER
<br />E.L. EACH ACCIDENT $ 1,666,66
<br />E.L. DISEASE -EA EMPLOYE $ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT Is 1,000,00
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Prof. Liability
<br />ZPL-13T10732
<br />1010112017
<br />10/01/2018
<br />Agg/Occ 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Mach ACORD 101, Additional Remarks Schedule, xmom 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 />�QY11�w l� �y
<br />+3orts� ►`�. K ar
<br />City of Santa Ana, its offic-
<br />ers, employees, agents and
<br />volunteers
<br />60 Civic Center Plaza
<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 />V 1980-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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