01/08/2024
Brown & Brown of Connecticut, Inc.
55 Capital Boulevard, Ste 102
Rocky Hill CT 06067
Dee Godlewski
[email protected]
Ubeo, LLC
401 East Sonterra Blvd
Suite 350
San Antonio TX 78258
American Zurich Insurance Company 40142
American Guarantee and Liability Insurance Company 26247 23-24 Master
A CPO 0738167 01 11/07/2023 11/07/2024
1,000,000
1,000,000
10,000
1,000,000
2,000,000
2,000,000
B BAP 0438610 01 11/07/2023 11/07/2024
1,000,000
PIP-Basic Statutory
B AUC 0773323 01 11/07/2023 11/07/2024
25,000,000
25,000,000
A WC 0738171 01 11/07/2023 11/07/2024
1,000,000
1,000,000
1,000,000
City of Burbank
301 E. Olive Ave ST 305
Burbank CA 91502
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $
$
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
Attachment 8
A&A Office Systems Inc
Braswell Office Systems Inc
Business Copy Associates, Inc.
CBSPRINT LLC dba Copy Zone,
COECO Office Systems. Inc.
Complete Business Systems Inc
Core Business Solutions, Inc.
Digital Enterprises, Inc
H&B Copies Inc dba Copy Corner
James B Schwab Co., Inc.
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
PrintRX LLC
Rainmaker Document Technology
Ray Morgan Company, Inc.
RMC A Ray Morgan Company, LLC
Seacoast Business Machines, Inc
Skillern’s Business Systems, Inc
UBEO Holdings, LLC
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Ray Morgan Company, LLC
Additional Named Insured
UBEO Midco, LLC
UBEO OF AUSTIN INC
UBEO OF EAST TEXAS INC
UBEO OF NORTH TEXAS INC
Ubeo West LLC
Centric Business Systems
United Reprographic Supply
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insured
Additional Named Insureds
Other Named Insureds
OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC