|
OP ID: LP
<br />AOC" R" CERTIFICATE OF LIABILITY INSURANCE
<br />OAT7/181DIY7
<br />0 711 812 0 1 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 WSURER(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 />1617 JFK Boulevard, Suite 880
<br />Philadelphia, PA 19103
<br />Paul J. Luccl
<br />CONTACT
<br />Paul Lucci
<br />PHONE FAx
<br />No Exn; 215.564.6971 wc.Na: 215.564-6975
<br />EMAIL
<br />PRDR5ss plucci@wortleypoole.com
<br />cut ER ID n: CLRDE-1
<br />INSURER(S) AFFORDING COVERAGE NAIC ffi
<br />-
<br />INSURED CLR Design, Inc
<br />833 Chestnut Street,Suite 1000
<br />Philadelphia, PA 19107
<br />INSURER A: Charter Oak Firs the Co. 25615
<br />INSURER B:Travelers Indemnity Co. ,2565$
<br />In
<br />INSURERS: sIndemnityCo. _ '25671
<br />XL Incurs
<br />INSURER D; XL 6peclalty Insurance Company 5
<br />3-7$$5
<br />$ 11066,600
<br />_
<br />INSURER E:
<br />X I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />INSURER F;
<br />COVERAGES CERTIFICATE NUMBER: Rc$nelnM Nu lenlacc.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INTR
<br />TYPE OF INSURANCE
<br />ADOLSBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDrflY
<br />POLICY EXP,
<br />MMIDD,YYYYLIMITS
<br />-
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 11066,600
<br />A
<br />X I COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />X
<br />680.2J979064
<br />07/11/2017
<br />07/1112018
<br />pREMISEG Eaoccurrenco
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ 10100
<br />PERSONAL B ADV INJURY
<br />$ 1,000,06
<br />_
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS-COMPIOP AGG
<br />$ 2,000,000
<br />POLICY PRO LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,600,066
<br />ANYAUTO
<br />BODILY INJURY (Par person)
<br />$
<br />B
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />�HIRED AUTOS
<br />BA-2728L15A
<br />0711112017
<br />07/11/2616
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTE
<br />(PER ACCIDENT)IDENT)
<br />$
<br />X NON-OWNEDAUTOS
<br />$
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,060
<br />AGGREGATE
<br />$ 5,000,000
<br />B
<br />EXCESS LI AB
<br />CLAIMS -MADE
<br />CUP -6736Y412
<br />07/11/2017
<br />07!9112018
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />C
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDED4 �
<br />NIA
<br />UB7302Y24A
<br />0711112017
<br />07111/2018
<br />WC STATU- OTH-
<br />X TO YJ,LMITS _�E
<br />E.L. EACIFI ACCIDENT
<br />_
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />__—
<br />$ 1,000,000
<br />(MandatoryInNH)
<br />der
<br />DESCRIPTION describe OP OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,060,000
<br />D
<br />Professional
<br />DPR9915991
<br />07/11120171
<br />0711112018
<br />Ea Claim 2,000,000
<br />Liability
<br />Am. Agy 2,606,"uu6
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: Agreement # A-2016.377
<br />--__ __.__,
<br />LREVIF..VJF„D UY�` Et1NiCE 11EREDIFl (PGP ()F 6��
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702-1988
<br />ACORD 25 (2009/09)
<br />SANTA -3
<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 />4 NI”
<br />The ACORD name and logo are registered marks of ACORD
<br />All rinhl5 rpRPNOA
<br />
|