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COPLOG1 OF ID: DI
<br />A�.. SmiKL:
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDl1'YYY)
<br />06/24113
<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 410. 228.6464
<br />RPS ISIS International
<br />204 Cedar Street 410- 228.7645
<br />Cambridge, MD 21613
<br />Jacque Brohawn
<br />CONTACT
<br />NAME: Diann Critrer
<br />AH2 E,t, 410- 901.0743 A"c No 410- 228 -7645
<br />nooalESS: Diann_Critzer@RPS!ns.com
<br />—
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC N
<br />INSURER A: Great American of New York
<br />22136
<br />INSURED Coplogic Inc
<br />231 Market Place #250
<br />INSURER B: Beazley USA Services, Inc.
<br />$ 1,000,000
<br />INSURER C
<br />X COMMERCIAL GENE
<br />CLAIMS -MADE � OCCUR
<br />San Ramon, CA 94583
<br />INSURER D
<br />SPP6175202
<br />08/01/13
<br />INSURER E:
<br />PREMISES Ea occurance
<br />$ 300,000
<br />INSURER F,
<br />$ 10,000
<br />PERSONAL B ADV INJURY
<br />COVERAGES CERTIFICATE NUMBER: RPVICinN NIIMRI =a•
<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 />TYPE OF INSURANCE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />POLICY NUMBER
<br />POLICVEFF
<br />MMIDDIYYYY
<br />POLICVEXP
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENE
<br />CLAIMS -MADE � OCCUR
<br />X
<br />SPP6175202
<br />08/01/13
<br />08/01/14
<br />PREMISES Ea occurance
<br />$ 300,000
<br />MED EXP(Any one person)
<br />$ 10,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />X POLICY PEo LOC
<br />PRODUCTS COMP /OP AGO
<br />$ 2,000,000
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED E EISINGLE LIMIT
<br />E
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />SPP6175202
<br />08101/13
<br />08/01114
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />X
<br />HIREOAUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />SPP6175202
<br />08/01113
<br />08/01/14
<br />AGGREGATE
<br />$ 5,000,000
<br />DED I X I RETENTION$ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOVERS'LIABILITY
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE V/N
<br />OFFICER/MEMSER EXCLUDED?
<br />NIA
<br />WC7576127
<br />08/01/13
<br />08/01114
<br />WC STATU OTH�
<br />X TORY LIMITS ER
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />E, L. DISEASE - EA EMPLOYEE
<br />1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E. L. DISEASE - POLICY LIMIT
<br />$ 1,0003000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Errors &Omisslons
<br />V15TTR130501
<br />08/01/13
<br />08/01/14
<br />Ded $25k $1 m /$3m
<br />& Network Security
<br />CLAIMS MADE & REPORTED
<br />Included
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach AC ORD 101, Additional Remarks Schedule, If more space is required)
<br />City of Santa Ana, CA is added as additional insured on the General PROVED AS TO FORM
<br />Liability coverage subject to the policy limitations, conditions m and exclusions.
<br />Laura A. Rossini
<br />Assistant city Attorney
<br />CERTIFICATE HOLDER CANCELLATION
<br />ATION
<br />CITYOSA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZEPOP D REPRESENTATIVE
<br />- l.L,.
<br />©1988 -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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