,ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)
<br />`..,.ram 05/02/2019
<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 the
<br />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 CONTACT
<br />,NAME Rodrigo Banuelos _ ,_„
<br />Dickerson Insurance Services, License #OM29112 (i NP, eaf)_(323) 45D-2374 _. _ (AID, N
<br />1;__.. _.
<br />1918 Riverside Drive EMAIL
<br />AODRess_ Rodrigo@dickersaD-9mup-Gom_.__.__
<br />Los Angeles CA 90039 INSURER(S) AFFORDING COVERAGE NAIC N
<br />(323) 662-7200 INSURER A. Philadelphia Indemnity Insurance Compaq_ _ _ 21044 __
<br />INSURED Charitable Ventures of Orange County INSURERS New York Marine & General Insurance Company 16608
<br />1605 E. 17th Street, Suite 101 INSURER c :_
<br />Santa Ana, CA 92705 INSURER D
<br />INSURER E:
<br />CO\/FRACFS CFRTIFICATF NIIMRFR• REVISION NIIMRFR�
<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 />"- - ADDL sUSR I POLICY EFF POLICY EXP .
<br />ILm
<br />WPEOF INSURANCE POLICY NUMBER 1 MMNONYYYI (MMoDNy"I LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE I S 1,000,000
<br />x COMMERCIAL GENERAL LIABILITY
<br />DAMAGE rORENTED
<br />PREMISES i$100000
<br />I_
<br />V
<br />IY
<br />Be occrenoe)
<br />CLAIMS-MADC L` OCCUR
<br />MED ENE (Any ane parson) ', $ 5,000 _
<br />A
<br />I
<br />PHPK1824618
<br />05/2112018
<br />07/15120191
<br />PERSONAL a ADV INJURY . s 1 000,000
<br />x Abfl MO BSlation Included
<br />GENERAL AGGREGATE s2,000,000
<br />-tlCN'L AGGREBATE LIMIT APPLIES PER.
<br />PRODUCTS - COMP/OP AGO, i 5 2,000,000
<br />X POLICY JE Dc
<br />'Abuse & Molestation s 1,000,000
<br />AUTOMOBILE LIABILITY
<br />_
<br />V
<br />��
<br />COMBINED SIN aLE LIMIT
<br />-U ac_ciden)_ ________
<br />5_1_,000,0.00_____,
<br />BODILY INJURY
<br />ANY AUTO
<br />(Per person)
<br />$
<br />ALL OWNED BCH EDULED
<br />l
<br />BODILY INJURY (P de )�
<br />$
<br />A
<br />_._ AUTOS
<br />. PHPK1824618
<br />05/2112018107/15/2019
<br />paoPEftW Dr.MAGE
<br />NON OWNED
<br />x HIRED AVTOS %� AUTOS
<br />_{PeLacrdent)
<br />s
<br />...
<br />j
<br />Deductible
<br />s 1,000
<br />UMBRELLA LIAB
<br />OCCUR
<br />r
<br />1
<br />EACH OOCURRCNCE S
<br />E%CESB LIAB
<br />CLAIMS -MADE
<br />AGGREGATE S
<br />DED RETENTIONS
<br />:5
<br />WORKERS COMPENSATION
<br />UMITSJ OER
<br />B
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVL YIN
<br />WG201800011228
<br />05111/2018
<br />07115/2019
<br />TORY
<br />EACH ACCIDENOFFICEIMEMBER
<br />RL
<br />—
<br />F
<br />E%OLUDED9Y
<br />N/A'
<br />y(MandnlaryleNH) DISEASE EAEMPLOYE
<br />E 1,000,000
<br />Ryes, descnbe undo,
<br />!1ON OF OPERAMONS below.
<br />EL DISEASE POLICY LIMIT
<br />_.
<br />$ 1,000,000
<br />IF—
<br />IF—
<br />I I
<br />❑ESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (AHacb ACORDiD1,AddIllonal Remarks Schedule, if more space is rs,.Ied)
<br />The City of Santa Ana, it's officers, employees, agents, and representatives are named as additional insured in regards to General Liability. The City will be
<br />mailed 30 days written notice of policy cancellation.
<br />City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFI
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORVEDREPREBE TATIVE
<br />©19 8-2010 ACORD CORE}QRATION rjphtsrq
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD �y
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