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MERCY-2 OP ID: SD
<br />'4`�.��'® CERTIFICATE OF LIABILITY INSURANCE
<br />DA09/21/2018Y)
<br />09121/2018
<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 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
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />CONTAE•CT Stephanie Dufour
<br />N M
<br />n °N a Er :714.369-2998Ic Na 714-840-6357
<br />E-M IL Ste hanie dufourinsurance.com
<br />aoDREss: p
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:GreatAmerican Insurance Com a
<br />16691
<br />INSURED Mercy Rouse Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />INSURER B:Great American Insurance Coma
<br />16691
<br />INSURERC:NOVA Casualty Company
<br />42552
<br />INSURER D:Great American Insurance Group
<br />37532
<br />INSURER E: Philadelphia Indemnity
<br />18058
<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 />ILTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />MMIDDCYN
<br />MMDCYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Q OCCUR
<br />Y
<br />PAC426088203
<br />05/02/2018
<br />0510212019
<br />PREMISES (Ear occurrence)
<br />$ 100,00
<br />MED EXP Anyoneperson)
<br />$ 10,00
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Prof. Liability 9/
<br />PAC426088203
<br />05/02/2018
<br />05102/2019
<br />X
<br />Sex Abuse/Miscond
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />A
<br />PAC426088203
<br />05/02/2018
<br />0510212019
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,00
<br />X POLICY.
<br />PRO - 0 LOG
<br />Ded: $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accid. t
<br />1,000,00
<br />BODILY INJURY (Per person)
<br />,-,__
<br />$�
<br />A
<br />ANYAUTO
<br />Y
<br />CAP 188045404
<br />05/02/2018
<br />05/0212019
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per acciden)
<br />$--
<br />X
<br />PROPERTY DAMAGE
<br />PERACCIDENT
<br />$ 130,00
<br />Comp/Coll Ded.
<br />$ 50
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />UMB 426088303
<br />05/0212018
<br />05/0212019
<br />DED I X I RETENTION$ 10000
<br />$
<br />C
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVEv
<br />(Mandatory In NHj ExcwoeD? L,-,,.I
<br />Ifyet, under
<br />OF OPERATIONS below
<br />NIA
<br />CF1-WK-10000043.00
<br />(ACCIDENT)
<br />DENT PHLY78928850
<br />02/08/2018
<br />1112112017
<br />02108/2019
<br />11/2112018
<br />X CSTAT - XTH-
<br />E
<br />EL. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,00
<br />D
<br />-DESCRIPTION
<br />Cyber Liability
<br />Y
<br />NLP3642944
<br />01/2912018
<br />01129/2019
<br />Per Occ 1,000,00
<br />E
<br />D&O/ EPLI
<br />Y
<br />PHSD1173663
<br />1011712018
<br />1011712019
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required) "
<br />City of Santa Ana, its officers, employees, agents, volunteers and I Q,.Q
<br />representatives are named additional insureds with respect to the operations v
<br />of the named insured & this policy is primary per the attached endorsement.
<br />Workes compensation coverage excluded, evidence only. 10 days notice of
<br />cancellation for non-payment of premium._ /VI nn
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Prank Hernandez
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />kI
<br />M
<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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