MERCY-2 OP ID: SO
<br />AI c'' CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 08/1f2016120 0
<br />20
<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 cartlFlcato holder Is an ADDITIONAL INSURED, the policy(los) 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 Ilou of such endorsements .
<br />PRODUCER
<br />Dufour Insurance Services, LLD
<br />5611 Littler Drive
<br />Stephanie Beach, CA 92849
<br />Stephanie Dufour
<br />CONTA T
<br />NAME: Stephanie Dufour
<br />PHONE �Xu,714�369.2998, �, ACAIC.Nop 714•BAO.5357
<br />Ae A . StB hanie dufourinsurance.com
<br />L �...•.......-.,,,.,,.-..,�...__.,.__,_.T.�...,„.._-,......___r..
<br />INSURER(S)AFFORDINGCOVERAGE
<br />NAICe
<br />INSURER A: Philadelphia Indemnity
<br />18058
<br />INSURED MorcyyHouse wing enters
<br />SantaO. AXa,C
<br />Santa Ana, CA 02702
<br />INSURERB:Philadelphia lndemnit
<br />18058
<br />INsuRERc:NOVA Casual Company
<br />42552
<br />INSURER D:Philadelphia lndemnit
<br />18058
<br />INSURERE:Azis Insurance Com an
<br />INSURER
<br />UUVERAGES rFRTIFirATF NIIMRFR• RptrIQIAU AH IMRCo.
<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 />TYPE OF INSURANCE
<br />POLICYNUMOP.R
<br />MMIU F
<br />M IDDIY POLICY E"
<br />LIMITS
<br />GENERAL LIABILITY
<br />�
<br />EACH OCCURRENCE
<br />$..-._..._ 1,000,00
<br />P
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAINSAIAGE OCCUR
<br />X
<br />X
<br />PHPK2127804
<br />05102/2020
<br />06102/2021
<br />REMISES Edo Rance
<br />$ 100,00
<br />MEtlEMYpne amOn7
<br />$ 10,00
<br />A
<br />X Prof. Liability
<br />PHPK2127804
<br />05/0212020
<br />05102/2021
<br />pcaSONusAbvINJURY
<br />s 1,000,00
<br />X
<br />Sex Abuse(Miscend
<br />GENERAL AGGREGATE
<br />It 2,000,00
<br />A
<br />PHPK2127804
<br />05/0212020
<br />05/0212021
<br />SENT AGGREGATE
<br />T POLICY
<br />LIMIT APPLIES PER:
<br />MPRO. LD
<br />PRODUCTS - COMP(OP AGO
<br />$ 2,000,00
<br />Ded.. $0
<br />It
<br />AUTOMOBILE
<br />_}-
<br />LIABILITY /
<br />n+"
<br />- LL
<br />LIM
<br />Me geol ..I
<br />1,000,00
<br />A
<br />ANYAUTO
<br />X
<br />X
<br />PHPK2127804
<br />05/02.12020
<br />05/02/2021
<br />BODILY INJURY(Porperaon)
<br />$
<br />XUOWNED
<br />X
<br />My
<br />AUTOS
<br />HIRED AUTOS X NONI�WNAUTOS EO
<br />/
<br />s
<br />BODILY -INJURY (Per acadon0ATOS
<br />RRACTIDEN GE
<br />$ 130,00
<br />Comp/Coll Ded.
<br />$ 50
<br />_
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,0000,00
<br />S
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />X
<br />X
<br />HUB720686
<br />05/0212020
<br />05/02/2021
<br />OED I X I RETENTION 10000
<br />C
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY y��
<br />ANY PROPRIETORIPARTNERIEXECUTIVEY"'-'n
<br />(Mandatory In NH EXGLUAEa? 11.....li
<br />(Mandatory )
<br />N yyes, tleaulbe under
<br />IRS71q 8belmv
<br />NIA
<br />X
<br />Ft-WK-10000043.04
<br />ACCIDENT PHLY78928850
<br />)
<br />02/08/200
<br />11121t2019
<br />0210"1
<br />11/21/2020
<br />X WG STATU- X TH-
<br />ELEACHACCIDENT
<br />...._.........._,.
<br />$ 1,000,00
<br />EL. DISEASE -EA EMPLOYEE
<br />$ 1,00000
<br />ELDISEASE. POLICY UMn
<br />$ 1,000,00
<br />E
<br />Cyber Liability ✓
<br />X
<br />X
<br />RPS AXIS P-077342120
<br />01129/2020
<br />01129f2021
<br />Par Occ 1,000,00
<br />D
<br />D&Ot EPLI
<br />X
<br />X
<br />IHSD1500500
<br />12/17/2019
<br />12117/2020
<br />Aggregate RQ�C�-. 1,000,09
<br />E
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 104, Additional Remarks Schedule, it more aside 1¢raqui ) R(
<br />City of Santa Ana, its officers, employees, agents, volunteers and By Risk MANAC14EMENT DIVISION
<br />representatives are namod additional insureds with respect to the operations
<br />of tha named insured & this policy is primary per the attached endorsement. ��yy q �T
<br />arkes compensation waiver of subrogation included. 30 days notice of �,.» 0 S 2020
<br />cancellation for non-payment of premium.
<br />ANgiE AcEVELIO
<br />r FRTNeIr:ATP unl Tipp HA.11I 1 I Is/ lsl
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana ✓
<br />Risk Management Division
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plata, Ath Fir
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE '1 ^_
<br />'� /w r c'L-qa�-t10
<br />01988.2010 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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