|
MERCY-2 OP ID: SD
<br />a� lzca CERTIFICATE OF LIABILITY INSURANCE
<br />DArEImMiDD Y)
<br />05/17/2019
<br />_
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLbER. 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 pofty(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 endorsement(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 />1�"FN q, E, :714.369.2998 _ a/c. No : 714.840-6357
<br />ADDRESS. Stephanieedufourinsurance.com
<br />---
<br />_ INSURERS) AFFORDING COVERAGE
<br />NAIC_p__
<br />INSURER A;Philadelphia Indemnity
<br />18058
<br />INSURED Mercy House Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />INSURER a:Philadel hia Indemnity
<br />18058
<br />INSURERC:NOVA Casualty Compan
<br />42552
<br />INSURERo:Philadelphia Indemnity
<br />18058
<br />INSURER E: Philadelphia Indemnity
<br />18058
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1-0 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 />INSR
<br />TYPE OF INSURANCE
<br />41707
<br />SUER
<br />POLICY NUMBER
<br />MMIO�Y�
<br />MMIODAE'YYY
<br />LIMITS
<br />A
<br />A
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIAeILITV
<br />CLAIMS -MADE 1XI OCCUR
<br />X Prof. Liability
<br />PHPK1976777
<br />PHPK1076777
<br />PHPK1976777
<br />0510212019
<br />05102/2019
<br />05/02/2019
<br />05IO2/2029
<br />05102/2020
<br />05/0212020
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />OA�PREMISES lEa occu rencel
<br />$ 100,00
<br />MED EXP (An ona person)
<br />$ 10,000
<br />PERSONAL&ACV INJURY
<br />$ 1,000,00
<br />X
<br />Sex Abuse1Miscond
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GEN'L AGGREGATE
<br />X1 POLICYF—I
<br />LIMIT APPLIES PER.
<br />PRO LOC
<br />PRODUCTS - COMPIOP AGO
<br />$ 2,000,00
<br />Ded: $0
<br />$
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />AALL
<br />UTOS NEO AUTOSULED
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PHPK1976777
<br />05102/2019
<br />05/02/2020
<br />COMBINED61NGLELIMIT
<br />E.nBdentL
<br />1,000,00
<br />BODILY INJURY(Par person)
<br />$
<br />BODILY INJURY (Per acclden)
<br />$
<br />PROPERTY DAMAGE
<br />PERACCIOENT)
<br />g 130,00
<br />Comp/Coll Ded.
<br />$ 50
<br />B
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />I
<br />OCCUR
<br />I CLAIMS -MADE
<br />PHUB674538
<br />05102/2019
<br />05/0212020
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />DED I X I RETENTION$ 10600
<br />$
<br />C
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOWPARTHE)EXECUTIVE YIN
<br />OFFICEWMEMBER EXCLUDED? El
<br />(Mand., In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />CFI-WKA0000043-03
<br />(ACCIDENT) PHLY78928850
<br />02108/2019
<br />11121/2018
<br />02/08/2020
<br />11/2112019
<br />X WC STATU- X TH.
<br />TORY LIMIT
<br />EL EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />D
<br />E
<br />Cyber Liability
<br />DSO/EPLI
<br />NLP3642944
<br />PHSD1173663
<br />01129/2019
<br />10117/2018
<br />01/29/2020
<br />10/1712019
<br />Per Occ 1,000,00
<br />Aggregate 11000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addlllonal Romarks Schedule, IF more space Is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />,
<br />(O 1988-2010 ACORD CORPORATION, All rights reserved. w
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|