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CERTIFICATE OF LIABILITY INSURANCE
<br />DA0212112019Y
<br />o2r2ar261s
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />CONTACT
<br />N AME: Stephanie Dufour
<br />Ac"u_369.2998 4840.6357
<br />No, E :714
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />E-MAIL Ske hanfe dutourinsurance.com
<br />ADDRESS: P
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICR
<br />CLAIMS -MADE a OCCUR
<br />INSURER A;Great_American Insurance Cornice
<br />16691
<br />$ 10,00
<br />_
<br />INSURED Mercy House Living Centers
<br />PA. Box 1905
<br />Santa Ana, CA 92702
<br />INSURER B: Great American Insurance Comps
<br />16691
<br />INSURER c: NOVA Casualty Company
<br />42552
<br />INSURER D:Greal American Insurance Group
<br />37532
<br />INSURER E:Philadelphia lndemnity
<br />18058
<br />A
<br />INSURER F:
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<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 />INBR TYPE OF INSURANCEEFW POLICY NUMBER 'MXP
<br />TR M@D EYY MM ODIYEYYY LIMITS
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,06
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y PAC426088203 0510212018 05102/2019
<br />PREMISES Ea oc�nDe<„-.e
<br />$ 100,00
<br />CLAIMS -MADE a OCCUR
<br />MED EXP (Anyone person)
<br />$ 10,00
<br />A
<br />X Prof. Liability
<br />PAC426088203 OW0212018 05/0212019
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />X
<br />Sex Abuse/Miscond
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />A
<br />PAC426088203 05102/2018 05/02/2019
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,00
<br />X _
<br />POLICY .. PRO- LOC
<br />Ded: $0
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,00
<br />AANYAUTO
<br />Y CAP 188045404 05/0212018 0510212019
<br />BDDILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />X
<br />BODILY INJURY (Per accident)
<br />.�. _..__
<br />$
<br />$
<br />AUTOS AUTOS
<br />X NON -OWNED
<br />IX
<br />PROPERTY DAMAGE
<br />$ 130,00
<br />WIRED AU709 AUTOS
<br />PER ACCIDENT
<br />....
<br />ComplColl Ded.
<br />$ 50
<br />X I UMBRELLA UAB X OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />B
<br />EXCESS LIAR CLAIMS-MADF
<br />Y LIMB 426088303 0510212018 05/0212019
<br />AGGREGATE
<br />$ 5,000,60
<br />DED X RETEMION$ 10000
<br />_
<br />$
<br />WORKERS COMPENSATION
<br />WE STAT47. OT}'I'
<br />X X
<br />AND EMPLOYERS' LIABILITY
<br />Y�
<br />TORY OMITS t3,
<br />C
<br />ANY PROPRIErORIPARTNER/EXECUTIVE
<br />CFI -WK -10000043-03 02108/2019 02108/2020
<br />F.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />(ACCIDENT) PHLY78923350 1112112018 11/21/2019
<br />E.L. DISEASE - EA EMPLOYE'
<br />$ 1,000,00
<br />Dyes, Resorunder
<br />DESCRIPTIOONN OF OPERATIONS below
<br />EL.DISEASE -POLICY LIMIT
<br />"'
<br />$ 1,000,00
<br />D
<br />Cyber Liability
<br />Y NLP3642944 01/2912019 0112912020
<br />Per Occ 1,000,00
<br />E
<br />D&O/EPLI
<br />Y PHSD1173663 10/1712018 1011712019
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space N roqulrod)
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named additional insureds with respect to the operations
<br />of the named insured & this policy is primary per the attached endorsement. gg
<br />Workes compensation waiver of subrogation included. 10 days notice of
<br />cancellation for non-payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />61988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Cit of Santa Ana
<br />City
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Frank Hernandez
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CIA 92702
<br />(w L J�
<br />61988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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