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OP ID: LP
<br />AcoRc3~ CERTIFICATE OF LIABILITY INSURANCE
<br />-�"-
<br />OATE(MMIDDMYY)
<br />07/18/2017
<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(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 />Wortley/Poole Professional, Ltd
<br />1 Penn Center
<br />CONTACT
<br />Paul Lucci
<br />PHONE FAX
<br />ac No E 1:215-564-6971 ac No 21S-564.6975
<br />1617 JFK Boulevard, Suite 880
<br />Philadelphia, PA 19103
<br />Paul J. Luccl
<br />E-MAIL lucci wortle oole.com
<br />pR@ yP
<br />PRODUCE'
<br />CUSTOMER to #: CLRDE-1
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED CLR Design, Inc
<br />INSURER A: Charter Oak Fire ins. Co.
<br />25615
<br />833 Chestnut Street,Suite 1000
<br />Philadelphia, PA 19107
<br />INSURER e : Travelers Indemnity Co.
<br />25658
<br />INSURER C: Travelers indemnity Co.
<br />25674
<br />INSURER D: XL Specialty Insurance Company
<br />37885
<br />MED EXP (Any one person) $ 10,00
<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 />ILTp
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUB
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD[YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE LA ] OCCUR
<br />X
<br />66D-2J979D64
<br />07/11/2017
<br />07/11/2018
<br />AMAGE TO RENTED
<br />PREMISES Ea occurrence $ 1,000,00
<br />MED EXP (Any one person) $ 10,00
<br />&ADV INJURY $ 1,000,00
<br />_PERSONAL
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS COMRADE AGG $ 2,013
<br />1-1 PEO LOC
<br />POLICY JC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDSINGLE LIMIT $ 1,000,00
<br />(Ea accident)
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />_
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />B
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />BA-272BL15A
<br />07/11/2017
<br />07111/2018
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT) $
<br />X
<br />NON -OWNED AUTOS
<br />$
<br />$
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />AGGREGATE $ 6,000,00
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP-673GY412
<br />07/11/2017
<br />07/11/2018
<br />DEDUCTIBLE
<br />$ -
<br />$
<br />RETENTION $
<br />C
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERAEXECUTIVEYIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />UB7302Y24A
<br />07/11/2017
<br />07/11/2018
<br />WCSTATU- OTH-
<br />TORY LIMITS ER
<br />_."
<br />E EACH ACCIDENT $ 1,000,09
<br />E. L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTIONOFOPERATIONSbelow
<br />I
<br />I
<br />"—
<br />I E, L. DISEASE -POLICY LIMIT $ 1,000,00
<br />D
<br />Professional
<br />DPR9915991
<br />07/11/2017
<br />07/11/2018
<br />Ea Claim 2,000,00
<br />Liability
<br />Ann Agg T3A 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 111 Additional Remarks Schedule, if more space is required)
<br />RE: Agreement # A-2016-377
<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTA -3
<br />SHOULD ANY OF THE ABOVE C PQJ,t IES BE CANCELLED BEFORE
<br />Cit of Santa Ana
<br />Y
<br />THE EXPIRATION DATE EREOF ICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THEOLICY PR7'/I IONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702.1988
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2009109)
<br />©1988.2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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