Laserfiche WebLink
Tori Digitally signed by <br />Tori Pierson <br />Pierson Date: 2021.07.21 <br />15:54:20-07'00' <br />'1 DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />07/02/2021 <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(ies) 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 endorsement(s). <br />PRODUCER <br />CONTA A DeJohn <br />Carriage Trade Insurance Agency, Inc <br />PHONEP,No (516) 358-5600 fAX Nu c (516) 358-5656 <br />ADORESS: ADeJohn@CarriageTradelnsurance.com <br />99 Tulip Avenue <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Suite 404 <br />INSURERA : Wesco Insurance Co. <br />25011 <br />Floral Park NY 11001 <br />INSURED <br />INSURER B <br />Lutheran Social Services of Southern California <br />INSURER C : <br />247 E Amerige Ave, Fullerton, CA 92832 <br />INSURER D : <br />INSURER E: <br />Fullerton CA 92832 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: CL217221303 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 TR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />POLICY EXP <br />MM DD/YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000.000 <br />CLAIMS -MADE � OCCUR <br />PREMISES Esocumnano6 <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />A <br />Y <br />WPP186062501 <br />07/01/2021 <br />07/01/2022 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE <br />$ 3.000.000 <br />POLICY JJEC LOC <br />PRODUCTS-COMP/OPAGG <br />$ 3,000,000 <br />Employee Benefits <br />s 1,000.000 <br />OTHER <br />AUTOMOBILE LIABILITY <br />COM81NED SINGLE LIMIT <br />Ea acudent <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />s <br />ANYAUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />I <br />WPP186062501 <br />07/01/2021 <br />07/01/2022 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTYDAMAGE <br />Per accidenA <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />E <br />Medical Expense <br />s 5,000 <br />X <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000,000 <br />HCLAIMS-MADE <br />AGGREGATE <br />$ 3,000,000 <br />A <br />EXCESS LIAB <br />WUM186635201 <br />07/01/2021 <br />07/01/2022 <br />DED I X1 RETENTION $ 10.000 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />E, L EACH ACCIDENT <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE- EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insureds as with respect to work performed by the Named Insured <br />as required by written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be Primary, and any <br />insurance carried by City shall be excess and noncontributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana <br />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 />W lAenagenu (hvi 1: <br />tiEYlEWE77 & APPROVED 8 V <br />01988-2015 ACORD <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk ManegementClenral/Lde <br />