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AC"Ra CERTIFICATE OF LIABILITY INSURANCE <br />ik - 7/1/2020 <br />o"Istmauo""Y"" <br />1 6/1/2020 <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 certificale holder Is an ADDITIONAL INSURED, the policy(tes) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain policies may require an endorsement A statement on <br />this certificate does not confer rights to the Certificate holder In lieu of such endorsements . <br />PRODUCER Lockton Insurance Brokers, LLC <br />N: N <br />777 S. Figueroa Street, 52nd FI. <br />PHONE FAx <br />E'a: ruc. xor <br />CA License 00FI5767 <br />Los Angeles CA 90017 <br />Ey"a <br />N AFFORDmO COVERA IE <br />RNC 0 <br />(213) 699-0065 <br />Mw A: Philadelphia Indemnity Insurance Co. <br />18058 <br />INSURED Community SeniorServ, Inc. <br />1448916 1200 N. Knollwood Cie <br />Anaheim CA 92801 <br />Narlltele a: Redwood Fire and Casualty Insurance CO <br />11673 <br />sls C: <br />INSURER o : <br />INauRERe: <br />INSURERF: <br />CUYrRAUEB C:UMNEIiI CERTIFICATE NUMBER: ISd7A77d OFVIRIrlu an MMCO. vvvvvvv <br />._.. _.. .._.... ... ......... .. .�....n n <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 MAW PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTRMR <br />TYPE OF NSVRANCC <br />POLICYWM M <br />roLIGY <br />LIMITS <br />A <br />�. <br />eOM CIALG&aRALEJAeatry;', <br />ClNM.4AII,DE © OCCUR <br />Y <br />N <br />PHPK2006119 <br />711n_019 <br />/ <br />7(0020 <br />EACH OCCURRENCE <br />51-.1000000. <br />PREMISES Eaoff—genreal <br />s 1000000 <br />MED EXP IA one rem) <br />a, 20,000 <br />PERSONA-LADVINJURY <br />s 1 OD0000 <br />GENL ADOREONELNTAPPUES PER <br />X POLICY ❑ JEcr Eloc <br />OENERN. AGOREOAM <br />s 3,000,000 <br />PROOUCrS-COMPIOP ADO <br />s 3 ODO O00 <br />It <br />OT FL <br />A <br />AIJTOMOBMELJANLITY <br />N <br />N <br />PHPK2005119 <br />7112019 <br />7112020 <br />EeacrNban U I <br />s t 000 jow <br />N <br />ANYAUTOOWPCED SCHEDULED <br />AUTOS ONLY <br />ONLY AUTOS ONLY <br />BODILY NNRY IPer wleMl) <br />f <br />somylRJURY(PMaxiass) <br />PROPERY D <br />TAUTOS <br />am <br />f )()( 00M <br />sxxxx (XX <br />s 1,000 <br />a 10000000 <br />A <br />X <br />MMERELuuAe <br />Occult <br />N <br />N <br />PHUB693732 <br />7/1/2019 <br />7112020 <br />EACH OCCURRENCE <br />"Case LLAS <br />QMI54MDE <br />AGGREGATE <br />f 10,000,000 <br />DED I X I RETENTIONS IO DDD <br />f xmxxx <br />B <br />INGRIKERS COMPENSATION <br />AND EMPLOYERS'W&Y <br />ANYPROPRIETORNARTNEWIXECtnNE <br />OFFICFRR.IEMBERIXCLUDEOT � <br />(MRndelery la NH) <br />H yyaaetleeraw antler <br />DESCRIPTION OF OPERATIONS aaaw <br />MIA <br />N <br />COWC0141133 <br />7112019 <br />7L�020. <br />✓ <br />EL EACH ACGDEM <br />f°S1'000Q— <br />E.L DISEASE -EA EMPLOYEE <br />_ <br />a 1 000 000._ <br />El DISEASE -POUCY LILUT <br />a 1 Q ,000 <br />DasCRIPTgMOFOPE"A SILOCATmNs IVEMCLES(ACORD lei, AtltlltlmH RamfAfBWtluN. mayb MIaNa411nron ryfu hraANVf4J <br />THISCERTIFMATE SUPERSEDESALL PREVIOUSLY IRSUED CERTIFICATES FOICTHR HOLDER. APPLICABLE TO THE CARRIERS LISFED,WD THE POLICYTERMIS) REFERENCED <br />The City of Santa Ana, its officers, employees, agents, representatives and volunteers are an Additional Insured to the extent provided by the policy language or <br />Endorsement t issued or approved by the insum �yrI1�.��'���;°�e• provided to Additional Insural(s) is primary and non-contributory as per the attached <br />cndoircmrntsorpolicylanguage ✓ BLYItV&D%APPROVED <br />y Risk MANAGEMENT DivisioN <br />JUN <br />CANCELLATION See <br />15476274 AA <br />— — <br />The City of Santa Ana, Risk ManageNiL( i CEVEdo <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana CA 92701 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPR <br />SIT <br />01 88.201 rACAD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />I <br />