COMMUNITY SENIORSERV INC. - Laserfiche WebLink

Home Browse Search

ACORO® CERTIFICATE OF LIABILITY INSURANCE 114.1 7/7/2019 DATE(MMIDD)YYYY) 1 7/3/2018 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. 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). PRODUCER Lockton Insurance Brokers, LLCONTACT 725 S. Figueroa Street, 35th Fl. CA License #OF15767 Los Angeles CA 90017 NAME: -- PHONE - FAX INC. No. Exit AIC No E-MAIL ADDRESS: (213)689-0065 INSURERS) AFFORDING COVERAGE NAICff INSURER A: Philadelphia Indemnity Insurance Co. 18058 — _ INSURED Community SeniorServ, Inc. 1448916 1200 N. Knollwood Cir. PF-0—LM-- I LY IU' INSURER B: Redwood Fire and Casualty Insurance Co 11673 INSURERC: Anaheim CA 92801 INSURER D: I $ INSURER E: AUTO MOBILELJABILITY _ INSURER F: i N ' PHPK1846716 COVERAGES COMSE01 CERTIFICATE NUMBER: 15476274 REVISION NUMBER: XXXXXXX 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. INSRADDL SUER LTR TYPE OFINSURANLE IN D WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDD/YYYY MM/DWYYYY LIMITS A COMMERCIAL GENERAL LIABILITY IY N PHPK 1846706 CLAIMS -MADE EXI OCCUR I EACH OCCURRENCE 7/1/2018 7/1/2019 -DAMAGE TO RENTED I PREMISES Ea occurn nce $ 1 000 O00 $ 1000000 MED EXP (Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENE AGGREGATE LIMIT APPLIES PER: POLICY JECT E' LOC GENERALAGGREGATE PRODUCTS - COMP/OPAGG $ 3,000,000 $3,00000 OTHER: I $ A AUTO MOBILELJABILITY IN i N ' PHPK1846716 7/1/2018 7/1/2019 COMBINED SINGLE LIMIT �a accident)1,000 i. $ QQQ $ XXXXXXX X ANY AUTO BODILY INJURY (Per person) OWNEDSCHEDULED AUTOS ONLY X AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) _ � PROPERTY DAMAGE Aper accitlent) _ , $ XXXXXXX I $ XXXXXXX $ 1,000 Com 1Co1LDed. A X ,,, UMBRELLA LIAB X OCCUR N N PHUB637625 7/1/2018 7/1/2019 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED4 N NIA N COWC9279$7 7/1201$ 7/1/2019 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ ] 000 000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT :$ 1000000 i DESCRIPTION OF OPERATIONS / LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, my be attached B more space is required V The City of Santa Ana, its officers, employees, agents, and representatives wean Additional Insured to the extent provided byyyy lie a �ed endorsement issued or approved by the insurance carrier. Insurance provided to Additional Insured(s) is primary and ry3ry�'Ei agcy a\ e [he endorsements or policy language. ''CC�� IU�A. wi a� c x\4\ �Pd 15476274 The City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD