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MERCY-2 OP ID: SO <br />AFRO CERTIFICATE OF LIABILITY INSURANCE <br />ffYM <br />DA06/161D12020 <br />06/1620 <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 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 />NAMEA T Ste hanie Dufour <br />_ <br />veONE _714-369-2998 SIC No: 714-840-6357 <br />DaL .Ste hanie dufourinsurance.com <br />Huntington Beach, CA 92649 <br />Stephanie Dufour <br />INSURERS AFFORDING COVERAGE <br />NAIC0 <br />INSURER A: Philadelphia Indemnity <br />18058 <br />INSURED Mercy House Living Centers <br />Santa Ana, CA 92702 <br />SantaAna,C <br />INSURER B: Philadelphia Indemnity <br />18058 <br />INSURERC:NOVACasual Company <br />42552 <br />INSURER D: Philadelphia Indemnity <br />18058 <br />INSURER E: Axis Insurance Company <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 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 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 />R <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMIDO <br />MMI <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />f 1,000,00 <br />P <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />X <br />PHPK2127804 <br />05/0212020 <br />05102/2021 <br />PREMISES Ea «anence <br />f 100,00 <br />CUIMS-MADE QOCCUR <br />MED EXP(My one Person) <br />f 10,00 <br />PERSONAL f ADV INJURY <br />$ 1,000,00 <br />A <br />X Prof. Liability <br />PHPK2127804 <br />0510212020 <br />05/02/2021 <br />X <br />I Sex Abuse/Miscond <br />GENERAL AGGREGATE <br />s 2,000,00 <br />A <br />PHPK2127804 <br />05/0212020 <br />05/02/2021 <br />DEVIL AGGREGATE LIMIT APPLIES PER <br />PRODUCTS -COMPMPAGG <br />f 2,000,00 <br />Ded: $O <br />f <br />X POLICY 7 PR6 LOG <br />AUTOMOBILE LIABILITY <br />COMBA <br />accident)Ea lNED SINGLEIT <br />1,000,00 <br />BODILY INJURY(Pw Penwn) <br />f <br />ANYAUTO <br />X <br />X <br />HPK2127804 <br />05102/2020 <br />05102/2021 <br />BODILY INIURY(Pv ac enl <br />f <br />X ALL OWNED X SCHEDULED <br />AUTOS 1I AUTOS X HIREDAUTOS X NON-0WNED <br />AUTOS <br />ft A E <br />(PER ACCIDENT) <br />f 130,00 <br />ComplColl Ded. <br />f 50 <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />f 5,000,00 <br />AGGREGATE <br />f 5,000,00 <br />g <br />EXCESS LIAR <br />CLAIMS -MADE <br />X <br />X <br />HUB720686 <br />05102/2020 <br />05/02/2021 <br />DED I X I RETENTION 10000 <br />f <br />WORKERS COMPENSATION <br />X WCSTATU- X TIF <br />MITS <br />C <br />A <br />�/ <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER,EXECUTIVEYO <br />I"M Etoryn NH�EXCLUDEO? <br />NIA <br />X <br />Fi-WK-10000043-04 <br />ACCIDENT) LY78928850 <br />02108120)11 <br />11/21/'F019 <br />02108501 <br />1112112020 <br />EL. EACH ACCIDENT <br />f 1,000.00 <br />EL. DISEASE-EAEMROYE <br />f 1,OOQ00 <br />EL DISEASE -POLICY LIMB <br />1 f 1,000,00 <br />n yea. deSC(ioe undel <br />DESCRIPTION OF OPERATIONS below <br />! <br />E <br />Cyber Liability -i <br />X <br />X <br />PS AXIS P-OT7342120 <br />0112912020 <br />01/2912021 <br />Per Occ 1,000,00 <br />D <br />D8.01 EPLI <br />X <br />X <br />HSDIS06508 <br />12/1712019 <br />1211712020 <br />Aggregate 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AnscE ACORD 101, Additional RemaMs S[hedula. lfmorespece is rPRulr ) <br />City of Santa Ana, its officers, employees, agents, volunteers and By RISk MANAGEMENT DIVISION <br />representatives are named additional insureds with respect to the operations <br />of the named insured 6 this policy is primary per the attached endorsement. O <br />4 <br />orkas compensation waiver of subrogation included. 30 days notice of 2020 <br />cancellation for non-payment of premium. , . <br />ANC{IE ACEVEdo <br />r..FRTIFIGATF HOL nFR CANCELLATION <br />/ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />J <br />THE EXPIDATE THEREOF. WILL BE DELIVERED IN <br />City of Santa Ana <br />ACCORDANCEION WITH THE POLICY PROVISIONSE <br />Risk Management Division <br />20 Civic Center Plaza, 4th Fir <br />Santa Ana, CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />