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Attu t/rtC►' MERCY-2 OP IC; SD
<br />+._ CERTIFICATE OF LIABILITY INSURANCE DATE(MMtUWYY y
<br />THIS CERTIFICATE IB issum AB A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON SHE CERTIFICATE HOLDE/2019
<br />R, 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: "this Certificate, holder Is art ADDITIONAL INSURED, the pollcy(IAS) must bs endaraed. B SUBROGATION 1S WAIVEOil sub)eat to
<br />the Irma and randitione of the Pelicy, certain policies may require an endorsement A statement an this certificate does not senior rights to the
<br />cortiicate holder In ilou et such endorsements .
<br />PRaouasa NAMEAe Stephanie Dufour
<br />Dufour Insurance Services, LLC -
<br />8811LittierDrive--..—.—._
<br />Huntington Beach, CA 92849 P ur .Ea0L714388.2990 _ �� x,. 714-540�8857
<br />INSURED
<br />92702
<br />THIS Y THAT THE POLICIES OF INSURANCE LISTED BELQW HAVE BEEN.I6SUED 70 THE INSURED NAM D ABOVE OR
<br />TO C:0PY
<br />A FOR THE POLICY
<br />INDICATED. ITHS7ANDIND ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
<br />PERIOD
<br />WITH RE15PROT TO
<br />CERTIFICATEBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
<br />WHICH THIS
<br />DESCRIBED HEREIN IS SUBJECT TO ALL
<br />EXCLUSIONS CONDITIONS OF SUGH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED SYPAID
<br />THE TERMS,
<br />CLAIMS.
<br />LaR TPINSURANCE POLICY UMBER
<br />GENERAL UAm4lTY
<br />EACH OCCURRENCE S
<br />A X,COMMERCIALGENERALLIABILITY I X X PIAPKf970T77 05/0212010 00/02/2020 aAElAa7(:'�a-
<br />lraaa,a0
<br />a
<br />_ CLAIMS-FADE[XI OCCUR
<br />10000
<br />MEDEXP(AAywep0rsan) S
<br />A X�Prof.Liabili1U PHPK1978T7T
<br />xe..._._, 0S1=2019I08/022020. PERSONALAAOVINJURY
<br />10,00
<br />A E�SozAbuse/MiaGand S
<br />PHPK99707T7 05/0212019 0510212020
<br />1,QOtlQ
<br />.` GENE AGGREGATE s
<br />OEMLAGGREGATE LIMIT APPLIES PER; PR06UC78.04MP/OP
<br />`X
<br />2,000,00
<br />AGG S
<br />I POLICY P 0- Lqp
<br />2r00Q,00
<br />Dad.• $0
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<br />S
<br />1000 00
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<br />AUTO
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<br />PER E DEN A �
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<br />OCCUR
<br />aXCeaSA
<br />Ia50272019I
<br />OOV2020
<br />EACHCOCURRENCE
<br />$
<br />Sr000,00
<br />DEO E10000
<br />AGGREGATE
<br />6,000,00
<br />X WC aTATtA' O
<br />Y lMITe,f X ER
<br />S
<br />O
<br />WORKBRB CWlPENSATION
<br />AND EMPLOYERS UABILnY
<br />'
<br />X
<br />ML. EACH ACCIDENT
<br />$
<br />1,000,00
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<br />fiFF',CERMEIA9�RXCW EniB� EY�
<br />NIA
<br />igP1-WK+1000004$=Q$
<br />a210812099
<br />92/0$12020
<br />U .6d ft In wilbaUH)
<br />I( 6 daxAbb U1M1K
<br />I(ACCiDENT)
<br />pHkY7S929S&0 � IV21/2018
<br />11/2112019
<br />E,L�CISEr18E•EAEMPtOYE
<br />S
<br />1r00tlr00
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<br />❑ SGIRIPn OF OPERATIONR
<br />Pyber Liability
<br />X
<br />X
<br />!
<br />NLP3042044 01129/2019
<br />01112812020
<br />E.L. OISEASEuPD}ICY LIMB
<br />Per Oce
<br />S
<br />1,000,QO
<br />E
<br />D&O/ EPLI
<br />X
<br />X
<br />PHSD1173083 110117M018
<br />10/17/2019
<br />Aggregate
<br />1,000,00
<br />1,000,00
<br />DESOWPTION OF OPERATIONS/ LOCATIONS I VIINCLES (Ahnh ACORD 101, Addlhonal Remits SCWWI1, 0 mine $0110e Ig .0md)
<br />City of Santa. Ana, its officers, Ms loyses, agents, volunteers and
<br />representatives are named
<br />additional insureds with respect to the operations
<br />of the named insured & this policy is primary par the attached endorsement.
<br />Norkes oompeneation waiver of subrogation included.
<br />90 days notice of
<br />Canoellatxon for non-payment of premium,
<br />REVIEWED & APPROVED
<br />•
<br />cpDTIW1RLTC un, mco _ ..... _. _ __
<br />Utz 06 2019 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIYEREO IN
<br />Risk Management Olvisia NTHA M. LA ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza, 4th Fir
<br />39Ma Ana, CA 92702 AUTRORUFO REPRESENra1NE
<br />'��{�p
<br />W 1988.2010 ACORD CORPORATION, Alt rights reserved.
<br />•-- -=-a, ,.rm nr..vrtu name ano 1090 are registered mad(S Of ACORD
<br />
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