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MERCY-2 OF ID; SD
<br />a �rrn CERTIFICATE OF LIABILITY INSURANCE
<br />DA0511712019TE )
<br />05117l2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT$ 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 forms 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 />Dufourinsurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />co"TAT Stephanie Dufour
<br />PHON
<br />"No.Ext1714.369-2996 AIc Na; 714.840-6357
<br />A oaess: Stephanie@dufourinsarance.com
<br />- —
<br />_
<br />INSURER(S)AFFOR_OINGCOVERAGE
<br />NAIC4
<br />INSURER A: Philadelphia indemnity T�
<br />18058
<br />INSURED Mercy House Living Centers"—
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />INsuRER e:Philadelphia in eeillnit
<br />18058
<br />INSURERC :NOVA Casual�Company_
<br />INSURER D: Philadel hialndamnity
<br />--
<br />42552
<br />18058
<br />INSURER E: Phtladm elphla Indemnity
<br />18058
<br />INSURER F W
<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 />LT
<br />TYPE OFIN$0RANCS
<br />BR
<br />POLICY NUMBER
<br />POLIdY EFF
<br />M Dp,E(,YYY
<br />PO C EXP
<br />MMIDO
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMh1ERCIALGENERALLIABILITY X
<br />X
<br />PHPK1976777
<br />0510212019
<br />05102/2020
<br />"DAMXGETrVRERTE15' PREMISESrEaoccuo-onw)
<br />_._._
<br />$ 10Q00
<br />CWtM3-MADE �X OCCURM@D
<br />EXP (Any one parson)
<br />$ 10,00
<br />„ CPS0NAL&A0Y INJURYn
<br />$ 1,000,00
<br />A
<br />_
<br />X Prof. Liability
<br />PHPK1976777
<br />0510212019
<br />M0212020
<br />A
<br />X Sex Abuse/Miscond
<br />PHPK1976777
<br />05/0212019
<br />0510212020
<br />$ 2,000,00
<br />_GI-NERALAGGRECATE
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />Ded: $O
<br />$
<br />X POLICY PRO TOO
<br />AUTOMOBILE LIABILITY
<br />U'a -B-INI M IN IT
<br />1,000,00
<br />A
<br />ANYAUTO X
<br />X
<br />PHPKI976777
<br />05102/2019
<br />OV0212020
<br />BODILY INJURY( Par UQPWl
<br />$
<br />BODILY tNJtiRY {PeraccitlaPij
<br />$
<br />ALL OWNED "CHEEOULEO
<br />x
<br />AUTOS AUTOS
<br />FFi6PE Ri D} AMAGE _..........
<br />F RAOCID NT
<br />v�
<br />$ 130,00
<br />OWNFO
<br />X X
<br />HIRED AUTOS AUTOS
<br />ComplCoil Ded.
<br />$ 50
<br />X
<br />UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE.
<br />$ 5,000,00
<br />B
<br />EXCESS LIAR _ CLAIMS MADE X
<br />X
<br />PHUB674538
<br />06/02/2019
<br />05/02/2020
<br />AGGREGATE
<br />$ 5,000,00
<br />$
<br />LED X RETENTIONS 10000
<br />WORKERS COMPENSA7ION
<br />x WCETA,IT- X TH-
<br />C
<br />AND EMPLOYERS' LIABIU Y
<br />ANY PROPRIETORIPARTNEPJEXECUTIVE Y(�"1
<br />X
<br />CFI-WK-10000043.03
<br />0210812019
<br />0270812020
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E
<br />OFFiCHR"SMSER EXCLUDED? NIA
<br />(Mandatory In NHy
<br />(ACCIDENT}pHLYT8926850
<br />9112112018
<br />11121l2019
<br />_
<br />R1, DISEASE - EA EMPLOYE
<br />$ 1100%00
<br />If DESa�RdsOue undo,
<br />IPTION OF OPERATIONS below
<br />E.L.DISEASE POUCYLIMIT
<br />$ 1,000,00
<br />D
<br />Cyber Liability X
<br />X
<br />NLP3642944
<br />01/2912019
<br />0112912020
<br />Per OGC 1,000,00
<br />E
<br />D&0l EPLI X
<br />X
<br />PHSD1173663
<br />10/17/2018
<br />1011712019
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES {Attach ACORD W, Admionai Remaeks Schaduta, if more space is repaired)
<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 S this policy is primary per the attached endorsement.
<br />Workas compensation waiver of subrogation included. 10 days notice of
<br />cancellation for non-payment of premium. _ r
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CI of Santa Ana
<br />City
<br />THE EXPIRATION DATE THEREOF, NOTICE WILT. BE DELIVERED IN
<br />Frank Hernandez
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />.«.��
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />(01988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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