|
mwagsmffi•` ! !
<br />A rzv..
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />TE IMMDNYYY)
<br />DA02/21/2019
<br />9zrzvzals
<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 endorsemen# s .
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />CONTACT Stephanie Dufour
<br />NAME:
<br />_
<br />°A Z ..714.36992998 LA No): 71 14-840.8357
<br />F,MAILss: Stephanie@dufourinsurance.com
<br />INSURERS AFFORDING COVERAGE NAC#
<br />A
<br />INSURER A: Great American Insurance Compa 16691
<br />INSURED Mercy House Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />_
<br />INSURER a: Great American Insurance Compa 16691
<br />INSURER C: NOVA Casualty Company 42552
<br />INSURER D: Great American Insurance Group 37532
<br />...................
<br />INSURER E: Philadelphia Indemnity 18058
<br />INSURER F:
<br />A
<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 />/LTR
<br />^TYPE OF INSURANCE DDL
<br />NSR
<br />U
<br />WW_
<br />POLICY NUMBER POLICY EFS
<br />MM �DIYEX LIMITS
<br />Santa Ana, CA 92702
<br />GENERAL LABILITY
<br />EACH OCCURRENCE $ 1,000,09
<br />A
<br />X COMMERCIAL GENERAL LIABILITY Y
<br />PAC426088203 05102!2018
<br />E ftEN .....�_.
<br />0510212019 PREMISES Ea oc�rran s 100,00
<br />CLAIMS-MACEI OCCUR
<br />MED EXP {Ary one person} $ 10,99
<br />A
<br />X Prof. Liability
<br />PAC426088203 0510212018
<br />05102/2019 PERSONAL& ADV INJURY $ 1,000,00
<br />A
<br />X Sex AbuselMiscond
<br />PAC426088203 05/02/2018
<br />05/02/2019 GENERAL AGGREGATE $2,000,00
<br />_
<br />GEN1 AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS-COMP/OPAGG $ 2,009,09
<br />_X1 POLICY JECTPRO- LOC
<br />Dad: $0 $
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,999,90
<br />To accldenl
<br />AANY
<br />AUTO Y
<br />CAP 188045404 05/0212018
<br />05/02/2019 BODILY INJURY (Per person) $
<br />ALL OWNED X SCHEDULED
<br />AUTOS
<br />BODILY INJURY (Per asocant) $
<br />X HIREDAU'rOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $ 130,00
<br />PERACCIDENT
<br />Comp/Coil Dad. 8 50
<br />X UMBRELLA DAB X OCCUR
<br />EACHOCCURRENCE $ 5,990,99
<br />B
<br />ExcEss LIAB CLAIMS -MADE Y
<br />DMB 426088303 0510212018
<br />0510212019 AGGREGATE $ 5,900,99
<br />D'cD X RETENTION$ 10009
<br />$
<br />WORKERS COMPENSATION
<br />X WC STATU- X OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />ORY LIMITS _--
<br />C
<br />ANY PROPRIETOR/PARTNEREXECUTIVE
<br />CFt-WK-10000043.03 02/0612919
<br />02106/2020 E.L. EACH ACCIDENT $ 1,000,99
<br />E
<br />OFFICEWMEMBPR EXCLUDED? NIA
<br />(Mandatory In NH)
<br />(ACCIDENT) PHLY78928850 11/2112016
<br />-- ---
<br />11/21/2019 E.L. DISEASE-EAEMPLOYEL$ 1,000,09
<br />Iyea,dea rits.undo,
<br />DE 5CRIP'IION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />D
<br />Cyber Liability Y
<br />NLP3642944 01/2912019
<br />01/29/2020 Per Occ 1,000,00
<br />E
<br />D&O/EPLI Y
<br />PHSD1173663 10/1712018
<br />10/17/2019 Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and IYyOYp
<br />representatives are named additional insureds with respect to the operations
<br />of the named insured & this policy is primary per the attached endorsement. RR✓"
<br />Workes compensation waiver of subrogation included, 10 days notice, of G
<br />cancellation for non-payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Santa Ana
<br />City
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Frank Hernandez
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|