|
CLRI]E-1
<br />OP ID- LP
<br />1 4C7"M" 1
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE iMM1DDIYYYYi
<br />0312412617
<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 endorsement(s).
<br />PRODUCER 215-564-6976
<br />CO_UANTACT __Paul LUCCI
<br />WortleylPoole Professronal,Ltd
<br />1 Penn Center
<br />1617 JFK Boulevard Suite 680
<br />Philadelphia, PA 1903
<br />Pau! J. Luccl
<br />PHONE 216-664-6970 FAX 215-664.6975
<br />(AlC, No, Ex0; IAlC, No ;
<br />E-MAIL UGCI WOrtle
<br />ADD • p yp00 e.COm
<br />_INSURERISI AFFORDING COVERAGE NAIC #
<br />INSURER A: Charter Oak Fire Ins, Co. 25616
<br />68D-2727LL060
<br />INSURED CLRDesign Inc
<br />833 Chestnut St., Suite 1000
<br />Philadelphia, PA 19107
<br />INSURER B;TraverersProperty Casualty Co 25674
<br />INSURER C : Travelers Indemnity Co, 25658
<br />INSURER D: Travelers Casualty and Surety 19038
<br />MED EXP (Any oneperson) 10,000
<br />INSURER E ; XL Specialty Insurance Company 37885
<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 />INSR
<br />L
<br />TYPE OF INSURANCE
<br />ADDL
<br />D
<br />SUER
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />W)
<br />POLICY EXP
<br />(M 10
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7 OCCUR
<br />X
<br />68D-2727LL060
<br />07111/2016
<br />07111/2017
<br />EACH OCCURRENCE $ 1,000,000
<br />DAMAOETORENcErrence 1,060,000
<br />MED EXP (Any oneperson) 10,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />POLICY JERO LOC
<br />GENERAL AGGREGATE $ $000,000
<br />PRODUCTS - CCMPIOP AGG S 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea 11.11 ED 81NOLE LIMIT $ 1,000,000
<br />RODILYiNJURY Perperson)$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BA -27281_115A
<br />0711112016
<br />0711112017
<br />'—
<br />BODiLYINJURY Per accident)$
<br />PROPERTY AMAGE
<br />Per accident $
<br />X
<br />H RED '( NON -OWNED
<br />A TDS DNLY AUTOS ONLY
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,900,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />CUP -6736Y412
<br />0711112016
<br />07!1112017
<br />AGGREGATE $ 6,000,000
<br />DED RETENTION$
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERlEXECUTIVE
<br />OFFICE OV1 oryIn NH EXCLUDED?
<br />(Manda)
<br />If yes, describe under
<br />N I A
<br />UB73D2Y24A
<br />07!1112016
<br />0711112017
<br />X PER OTH.
<br />STATllT ER
<br />E.L, $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE 1,000,000
<br />DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS belowE.L.
<br />E
<br />Professional
<br />OPR9807064
<br />0711112016
<br />0711112017
<br />Ea Claim 2,000,000
<br />Liability
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES [ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) �� °
<br />RE: Agreement # A-2016-377
<br />SANTA -3
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702-1988
<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 />r./-
<br />ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|