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Last modified
4/28/2022 9:56:42 AM
Creation date
8/7/2018 12:57:02 PM
Metadata
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Template:
Contracts
Company Name
WELLDYNERX
Contract #
A-2018-131
Agency
Public Works
Council Approval Date
5/15/2018
Expiration Date
6/30/2020
Insurance Exp Date
2/16/2023
Destruction Year
2025
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R CERTIFICATE OF LIABILITY INSURANCE <br />DATE YI <br />le. <br />�' 2/16/2018 <br />2/9/2018 <br />18 <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 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 certificate holder in lieu of such endorsament(s). <br />PRODUCER LOCkton Com PameB <br />8110 E� Union Avenue <br />Sulte 700 <br />DenverCO80237 <br />NEA <br />T <br />FAX "el; <br />ac�rlo, eS.n: --- <br />---_ <br />E.rn IL <br />AMR'65: _ <br />(303)414-6000 <br />INSUBERISIAFFORDN COVE <br />INSURER A: Arch Specialty Insurance Comeany <br />21199 <br />INSURED WellDynER%'i LLC. <br />1424829 500 Eagles Landing Drive <br />Lakeland, <br />Lakeland, FL 33810 <br />INSURER B: Zurich American Insurance Company <br />16535 <br />INSURER C: Lexineton Insurance Company <br />19437 <br />INSURER D: Lloyds of London <br />iNsunER F Berkley Insurance Company <br />32603 <br />t <br />ERE: <br />COVERAGES CFRTIFICATFNIIMRFR- 1451AOR9 eclnelnu Eu larovo. vv v v v vv <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, 1'HE 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 />ILSR <br />Y <br />TYPE OF INSURANCE <br />ALM <br />INSD <br />SUER <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />2/16/2018 <br />POLICY EXP <br />2/16/2019 <br />LIMITS <br />A <br />x <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />N <br />N <br />FLP006017701 <br />EACH OCCURRENCE <br />_ <br />1,000,000 <br />DAM,AGE RENTED <br />PRE ISE EeoccurreD.QI <br />100,000 <br />MED EXP (Amyno ereon <br />$ 000 <br />PERSONAL BAOV INJURY <br />$]000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY] JECT LOG <br />GENERAL AGGREGATE <br />$3000000 <br />PRODUCTS - COMPIOPAGG <br />$ 3,000,000 <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />NI <br />N <br />Ff,P006017701 <br />2/16/2018 <br />2/16/2019 <br />COMBINED <br />MBIN DSINGLE-LIMIT <br />$ ] 000 000 <br />P <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per Person) <br />$ xxxxxxx <br />BODILY INJURY(Per aFddent <br />$ XXXXXXX <br />AUTOS ONLY X AUUTOSONLY <br />Pe�accc ^DAMAGE <br />$ xxxxxxx <br />$xxxxxxx <br />A <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />N <br />N <br />FLP006017701 <br />2/16/2018 <br />2/16/2019 <br />EACH OCCURRENCE <br />$ 10,000,000 <br />EXCESS LIAR <br />ICLAIMS -MADE <br />AGGREGATE <br />$ 10,000,000 <br />DED RETENTIONS <br />s xxxxxxx <br />B <br />ON <br />ANWORKERS OYERS'LA LIABILITY YIN <br />ANY PROPR ITFORIPARTNERIEXECLIC 1 <br />OFFICEWMEMDER EXCLWEP N <br />Ieen,deory In Nu <br />a . n.'s" 'den <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />N <br />WC014390901 <br />2/16/2018 <br />2/7/2019 <br />X einmTE DEH- <br />E L. EACH ACCIDENT <br />$ 1000000 <br />E.L. DISEASE - EA EMPLOYEE <br />1,000,000 <br />ELDBEASE-POLICY LIMIT <br />a 1000000 <br />A <br />C <br />D <br />E <br />Phmmac9 Prof. l.ieb <br />PBME9,OLiah, <br />Cyber <br />Cclme <br />N <br />N <br />PLP006017701 <br />012110742 <br />NIPLI84736417 <br />BCCR4500242320 <br />2/16/2018 <br />2/16/2019 <br />2/16/2017 <br />10/21/2016 <br />2/16/2019 <br />2/16/2019 <br />2I1 G/201R <br />2/]6/2018 <br />SIMIS3M <br />Limil:$8M/RDtS25I( <br />Limil:$5M Le, Clan,45M Aug <br />LimiC S2M per OcC, <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addillmal Remarks Schedule, may be sttachad 11 more space is required) <br />14516082 <br />Cityy of Santa Ana <br />AT N: Christy Kindig <br />20 Civic Center Plaza, M-21 <br />Santa Ana, CA 92701 <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 />ai)f <br />The ACORD name and logo are registered marks of ACORD <br />rinhbb roc. nmA <br />
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