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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 />