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MERCY-2 OP ID:
<br />A CERTIFICATE OF LIABILITY INSURANCE DA09121/201TE Y'
<br />09121/2018
<br />L
<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 />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />INSURED Mercy House Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />C:
<br />INSURER E: Philadelphia
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THF. POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDfi"ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
<br />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 />INSTYPE OF INSURANCE OL UBR POLICY NUMBER MPoVQQfYYYY MMIIQ YYYY
<br />R
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />1,000,00
<br />A X COMMERCIAL GENERAL LIABILITY Y PAC426088203 05/02/2018 05/02/2019
<br />ETO RENTED
<br />Pft EMISES(Ea occurrence „$ ,
<br />100,000
<br />CLAIMS -MADE OCCUR
<br />_ MEDE%P(Any ono,person) $
<br />10,000
<br />A X Prof. Liability PAG426088203 0510212018 0510212019
<br />PERSONAL a ADV INJURY $
<br />1,000,00
<br />A X Sex Abuse/Miscond PAC426088203 05/02/2018 05/02/2019
<br />cENERALAGGREQATE $
<br />2,000,000
<br />I GENLAGGREGATE IJMITAPPLIE.S PER'.
<br />PRODUCTS-COMPIOPAGG $
<br />2,000,000
<br />X PCX.IGY 2 LOC
<br />Dad: $0 Y $
<br />AUTOMOBILE LIABILITY
<br />COMBIN ED SIN('iLE LI MIT
<br />1,0OQ000
<br />A ANY AUTO Y CAP 188045404 05/02/2018 05/0212019
<br />-
<br />INJURY (Pei person) $
<br />ALLOPdNED ACT
<br />AUTOS AUTOS
<br />NONOWN _
<br />X ,V LO AUTO X -
<br />AUTOS
<br />BODILY
<br />BODaL INJURY
<br />SOIFLY INJURY (Per acadant) $
<br />$
<br />PROPERTY DAMAGE $
<br />PFR ACCIDENTI
<br />130,000
<br />i_
<br />IComplColl
<br />Ded. $
<br />50
<br />X ; UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE I 5
<br />5,000,00
<br />B EXCESS LIAB CLAIMS -MADE Y UMB 426088303 05/02/2018 05/02/2019
<br />gGGREGATE $
<br />5,000,000
<br />DED X RETENTION 10000
<br />$
<br />WORKERS COMPENSATION
<br />X VVC STATtJ- X TH-
<br />1QRY LIMP... ER
<br />ANDEMPLOYERS'UABILITY
<br />C ANY PROPRIETORIPARTNERIEXECl1TIVE YtN ICF1-WK-10000043-00 02/08/2018 02/08/2019
<br />_
<br />EL, EACH ACCIDENT
<br />1,600,00
<br />OFFICER/MEMBER EXCLUDED? NIA
<br />E (Mandatary in NH) !(ACCIDENT) PHLY78928850 11/21/2017 11/2112018
<br />_$
<br />E_L.,DISEASE-F.A EM PLOYEE $
<br />1,0002000
<br />If yee. daecrlba under
<br />DESCMr`7ON OF OPERATIONS Yw-i',.w
<br />E.t_UISEASE-POLtGY LIMIT $
<br />1,000,000
<br />D Cyber Liability Y INLP3642944 01/29/20 IS 01/29/2019
<br />Per Occ
<br />1,000200
<br />E D&O/ EPLI Y PHSD1173663 10/17/2018 10/17/2019
<br />Aggregate
<br />1,0002000
<br />DESCRIPTION OF OPERATIONS t LOCATIONS VEHICLES {Attack, ACORD 101, Additinnai Remarks Schedule, it more space is required}
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named additional insureds with respect to the operations
<br />IF C` I�.t�l1E
<br />of the named insured & this policy is primary per the attached endorsement. Workes compensation coverage excluded, evidence only. 10 days notice of
<br />cancellation for non-payment of premium.
<br />City of Santa Ana
<br />Frank Hernandez
<br />20 Civic Center Plaza Box 1988
<br />Santa Ana, CA 92702
<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 />ACORD 26 (2010105)
<br />CJ 1988-2010 ACORD CUKPORAHUN. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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