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AcoRDF CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYri)
<br />�a..�'' 7/1/2019 71 1 O'n 8
<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 INSURERS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER LOCkton insurance Brokers, LLC CONTACT
<br />725 S. Figueroa Street, 35th FI. PHONE-- -- PAX
<br />CA License MOF15767 _IA1C.INo Exit.
<br />Los Angeles CA 90017 AADMDARESS:
<br />(213)689.0065 INSURRIS) AFFORDING COVERAGE NAICp
<br />_ INSURERA Philadelphia Indemnity Insurance CD. _ 18058
<br />INSURED Community SeniorServ, Inc, f _wsuRERB. Redwood Fire and Casualty Insurance Co 11fi73
<br />1448916 Vk--&0)UR'- I iPL® 1200 N. Knolhvood Cir, IrvsuREa c: _
<br />Anaheim CA 92801 _._
<br />INSURER O:
<br />INSURERS: ..-. _.._.... __..
<br />INSURER F :
<br />COVFRAGFR COMSFOI CFRTIPICATF NIIIMRFR. IkAaloln oevlelnu ul uaoco.
<br />__ __. ____. _._.__._.__... ............I.
<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
<br />ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR CE INBO. WVD POLICYNUMBER
<br />R!
<br />�� POLICYEFF POUCYE7(P i
<br />(MMiDDNYYVI (MMIDDIYYYY ! LIMITS
<br />- - --_-
<br />COMMERCIALOGENERA6 LIABILITY
<br />A X, _ Y N.. YFIYKI$46706
<br />7/I/2018 7/I/2019 EACH OCCURRENCE
<br />,S_.1,000,000
<br />!
<br />CLAIMS MADE }(I OCCUR
<br />I - DAMAGE TO RENTED
<br />PREMISCSiEsoccuttence)
<br />,8 1,000,000
<br />MEDEXP(Any Ono person) ...
<br />_,$ 20,000
<br />PERSONAL BADVINJURY
<br />y5. J,000,00Q
<br />GEN'LAGGREGATE LIMITAPPLIESPER:
<br />'I
<br />!I GENERAL AGGREGATE
<br />$.3,000,000
<br />POLICY JECT', 1.03
<br />! PRODUCTS - COMPIOPAGG
<br />--
<br />S.3,000,000
<br />OTHER:
<br />$
<br />A AUTOMOBILE
<br />UABIUTY N N PFIPKI846706
<br />!7/112018 7/t/2019 COMBINED ISINGLE LIMIT
<br />X
<br />ANY AUTO !.
<br />BODILY INJURY (Per person)
<br />sXXXXXXX__.
<br />OWNED SCHEDULED
<br />OWNS ONLY X AUTOS
<br />`-_
<br />BODILY INJURY (Per accident)
<br />$ XXXXXXX.
<br />..
<br />HIRED NON
<br />ONLY AUTOS ONLY
<br />_jPeaacclCYDAMAGE ent5
<br />_ _
<br />XXXXXXX
<br />Coarp /Coll Ded
<br />s 1,000
<br />A X_'
<br />UMBRELLA LIAB N N Ii PHUIB637625
<br />7/1/2018 7/1/2019 EACH OCCURRENCE
<br />$ 10,000,900
<br />E%LESS LIAR CLAIMS -MADE II
<br />AGGREGATE
<br />$ ,10,000,000
<br />EN101000I
<br />$ XXXX
<br />IWORRERS COMPENSATION N
<br />iYIN COWC927987
<br />TryR
<br />7/1/T018 7/1/2019 STATUTE, ER
<br />.,-
<br />_
<br />'ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? NIA
<br />L,EL EACH ACCIDENT
<br />$ 1 OOO,OOO
<br />(Mandatary In NH) !.
<br />EL DISEASE EA EMPLOYEE $ 1,000a0Q0
<br />If yes, dI under
<br />DESCRIPTION OF OPERATIONS below
<br />IE.L. DISEASE POLICY UNIT
<br />$ 1000000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS) VEHICLES (ACORD 101,Additt... I Remarks Sehedule,. may be atleehed If more apace Is mquiretl ej
<br />The City of Santa Ana, its o(iicers, employees, agents, Additional Insured
<br />and representatives am an
<br />endorsement issued or approved by the insurance carrier. Insurance provided to Additional Insured(s)
<br />to the extent provided�by~�(Rt�fiolicy la ge or
<br />is primary and r{co9C' Yk )but a3t t is a ed
<br />endorsements or policy language.
<br />e
<br />t AIY4CLLH I JUN JCG ALLEUTIRlenl
<br />15476274
<br />The City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />2O CIVIC Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />CORPORATION, All
<br />AC IRD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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