|
ACORp MGTOFAM-01 CRYST.
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN7/23/2019
<br />D 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 policypes) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificaN, hnldar L. Ila- ^f a..,... __.------
<br />PRODUCER
<br />Earl Bacon Agencyy Inc.
<br />Post Office Box 121139
<br />Tallahassee, FL 32317
<br />INSURED
<br />MGT of America, LLC
<br />MGT of America Consulting, LLC
<br />4320 West Kennedy Blvd.
<br />Tampa, FL 33609-2118
<br />COVERAr;FS
<br />and Surety Companv of
<br />THIS
<br />- -- --�•�
<br />IS TO CERTIFY THAT THE POLICIES
<br />•r
<br />OF
<br />.. ,=
<br />INSURANCE
<br />numooK[
<br />LISTED
<br />REVISION NUMBER:
<br />INDICATED.
<br />CERTIFICATE
<br />NOTWITHSTANDING ANY
<br />REQUIREMENT,
<br />BELOW HAVE
<br />TERM OR CONDITION OF
<br />BEEN ISSUED
<br />ANY CONTRACT
<br />TO THE INSURED
<br />OR OTHER
<br />NAMED ABOVE FOR
<br />DOCUMENT
<br />THE POLICY PERIOD
<br />EXCLUSIONS
<br />MAY BE ISSUED OR MAY
<br />AND CONDITIONS OF SUCH
<br />PERTAIN,
<br />POLICIES.
<br />THE INSURANCE AFFORDED BY
<br />LIMITS SHOWN MAY HAVE
<br />THE POLICIES
<br />DESCRIBED
<br />WITH RESPECT
<br />HEREIN IS SUBJECT
<br />TO WHICH THIS
<br />TO ALL THE TERMS,
<br />INSR
<br />BEEN
<br />REDUCED BY
<br />PAID CLAIMS.
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />LIMBS
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS-MADEOCCUR
<br />X
<br />X
<br />5096130327
<br />7/1/2019
<br />7/112020
<br />DAMAGE TO RENTED
<br />300,000
<br />$
<br />MED EXP fAnyone rson)
<br />$ 16,000
<br />GEN'L AGGRE,�A�TE LIMIT APPLIES PER:
<br />PERSONAL a ADV INJURY
<br />$ 11000,000
<br />GENERALAGGREGATE
<br />2,000,000
<br />Palm,l YI�RO. ❑ LOC
<br />I!` ECT
<br />PRODUCTS-COMP/OP AGG
<br />2,000,000
<br />OTHER:
<br />EOMBINEO SINGLE LIMIT
<br />$
<br />S 1,000,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />SCHEDULED
<br />X
<br />X
<br />2093563501
<br />7/1/2019
<br />]/1/2020
<br />BODILY INJURY Per arson
<br />$
<br />A�UpTEO�$ ONLY
<br />BODILY E INJURY Pere¢Mant
<br />$
<br />X AUTOSONLY X AL%q
<br />Pe�sdtlwt MAGE
<br />NLV
<br />$
<br />B
<br />X UMBRELLA LIAR X OCCUR
<br />EXCESS LIAR CLAIMS -MADE
<br />2093663496
<br />711/201V
<br />7l1/2020
<br />EACH OCCURRENCE
<br />5,000,000
<br />DED X RETENTION$ 10,000
<br />AGGRE ATE
<br />5,000,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LU21UTY
<br />YIN
<br />X PER OTH-
<br />ANYCpPROPREIIUO�RRIPARTNERI ECUtIVE
<br />(MFandatoryln NER EXCLUDED?
<br />N/A
<br />X
<br />3011086788
<br />7/1/2019
<br />7/1/2020
<br />E.L EACHACCIDEM
<br />g 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />1,000,000
<br />If y¢s, desadba coder
<br />DESCRIPTION OF OPERATIONS Wim
<br />E.L. DISEASE - POLICY UMIT
<br />2,600,000 Occur/AGG>
<br />1,000,000
<br />D
<br />Professional Liab.
<br />105638880
<br />7/112019
<br />7/1/2020
<br />D
<br />Cyber Liability
<br />105638880
<br />7/1/2019
<br />7/112020
<br />5,000,000
<br />5,000,000
<br />DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES//ACORD 101,Additional Remarks$chedele,mayy b aftachedifmorespaceisrequired)
<br />Blanket Additional Insured per attached forms CG2010; CG2037; CNA750779XX; CA20480299
<br />Blanket Waiver of Subrogation per attached forms CNA75008XX; G1916OB; CA04440310
<br />Notice of Cancellation to Certificate Holders Per attached forms CC68021A; CNA72315XX
<br />THE CITY OF SANTA ANA, irs OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED AS ADDITIONAL
<br />'
<br />INSURED IN REGARDS TO
<br />GENERAL LIABILITY PER ATTARI�'@H7fIDgXac gaOep-rgOVE ffANKET ADDITIONAL INSURED FORMS.
<br />A-2018-112 rL.YYL1J &
<br />Ht"t"tCIJY
<br />A-2017-251 By RISk MANAGEMENTDIVISION
<br />CERTIFICATE HOI DFR
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF,
<br />A LAMBFRT ACCORDANCE WITH THE POLICY PROMS ONSCE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />M
<br />Risk Management AUTHORIZED REPRESENTATIVE
<br />rfyi
<br />20 Civic Center Plaza %y��'[ / �w—
<br />ISanta Ana CA 9 70 i�
<br />ACORD 25 (2016/031
<br />- u-cv rJ An UKU UUKYUKA I IUN. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|