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MERCY-2 OF ID: SO
<br />'4"?®' CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMlDO Y)
<br />0511712019
<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(Jos) 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 endorsements .
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />NAME: CONTACT Stephanie Dufour
<br />_
<br />PHONFAx
<br />AI E E 6 714.369-2998 1.f .. 714.840.6357
<br />'MAIL Ste Jhanie dufOUHnsuranCe.cOm
<br />ADOREsst............r..............he _
<br />r..__.....,._.............�
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC A
<br />^_
<br />INSURERA;Philadel hialndemnity
<br />18058
<br />UREb Mercy House Living Centers
<br />Santa Ana,ox
<br />Santa Ana, CA 92702
<br />INSURER a:Philadelphia Indemnity
<br />18058
<br />INSURER C:NOVA Casualf Company
<br />42552
<br />INSURER D;Philadal hiaindemnit
<br />18058
<br />INSURER E;Philadelphia lndemnit
<br />18058
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS 15 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 />INTR
<br />TYPE OF INSURANCE
<br />'NDRPOLICY
<br />NUMBER
<br />MM DD
<br />EXP
<br />MM„t0
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$. 1,000,00
<br />A
<br />X COMMERCIAL GENERAL
<br />'�
<br />CLAIMS MADE (OCCUR
<br />X
<br />X
<br />PHPK1976777
<br />06/02/2010
<br />05102/2020
<br />PREM_MqMGrT Ea osTuE
<br />rrence
<br />$ 10g,OQLIABILITY
<br />MED E%P (An one parson)
<br />$ 10,000
<br />PERSONAL&ADVINJURY
<br />$ 1,000,00
<br />A
<br />X Prof. Liability
<br />PHPK1976777
<br />05/02/2019
<br />0510212020
<br />X
<br />Sex Abuse/Miscond
<br />GENERAL AGGREGATE
<br />$ $000,00
<br />A
<br />PHPK1976777
<br />05/0212019
<br />05102/2020
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS. COMPIOP AGO
<br />$ 2,000,00
<br />X1 POLICY PRO LOC
<br />Dad: $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />ewid-0
<br />CEa O B E SN L LIMIT
<br />$ 1,000,00
<br />BODILY INJURY(Per person)
<br />$
<br />A
<br />ANY AUTO
<br />X
<br />X
<br />PHPK1976777
<br />05/02/2019
<br />05f02/2020
<br />X
<br />AUTOS ALL NED X SCHEDULED
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY(PeraccidenQ
<br />$
<br />IT OF Y AMA E
<br />PER ACCIDE T
<br />$ 130,00
<br />Comp/Coll Dad.
<br />$ 50
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />B
<br />EXCESS
<br />CIAIMS-MADE
<br />X
<br />X
<br />PHUS674538
<br />05/02/2019
<br />0510212020
<br />DED X RETENTIONS 10000
<br />$
<br />C
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERT LIAMI ITY
<br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN
<br />OPFICERIMEM9ER EXCLUbEU4
<br />(Mantlatary In NH)
<br />Ifyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />CF1.WK-10000043.03
<br />(ACCIDENT) PHLY78928850
<br />02/08/2019
<br />11121/2018
<br />02108/2020
<br />11121/2019
<br />X TO YLIMITS X OTH-
<br />E.L. EACH ACCIDENT
<br />_
<br />$ 1,000,00
<br />E,L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />'
<br />E.L. DISEASE- POLICY LIMIT
<br />$ 1,000,00
<br />D
<br />Cyber Liability
<br />X
<br />X
<br />NLP3642944
<br />01129I2019
<br />01129/2020
<br />Per Occ 1,000,00
<br />E
<br />D&O/EPLI
<br />X
<br />X
<br />PHSD1173663
<br />10/1712018
<br />10117/2019
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<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.
<br />Workes compensation waiver of subrogation included. 10 days notice of
<br />cancellation for non-payment of premium.
<br />City of Santa Ana
<br />Frank Hernandez
<br />20 Civic Center Plaza Box 1988
<br />Santa Ana, CA 92702
<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 />©1988.2010 ACORD
<br />reserved.
<br />ACORD 25 (2010105)
<br />The ACORD name and logo are registered marks of ACORD
<br />
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