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MERCY-2 OP ID: SO <br />.44CCWzo CERTIFICATE OF LIABILITY INSURANCE <br />OA06/1612020Y) <br />0611612020 <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 pollcy(les) 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 />Huntington Beach, CA 92649 <br />Stephanie Dufour <br />CONTACT <br />NAME: Stephanie Dufour <br />P"ONE .714-369-2998 arc NP: 714840.6357 <br />ODRESS.' St e hanie dufourinsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAICN <br />INSURER A:Philadelphia indemni <br />18058 <br />INSURED Mercy House Living Centers <br />P.O. Box 1905 <br />Santa Ana, CA 92702 <br />INSURERS: Philadelphia Indemnity <br />18058 <br />INSURER C:NOVA Casualty Company <br />42552 <br />INSURER 0:Philadelphia indemni <br />18058 <br />INSURER E: AXIS Insurance Company <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- <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 />IL R <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFF <br />MM/D <br />POLICY EXP <br />DD <br />LIMITS <br />GENERAL LIABILITY <br />EACHOCCURRENCE <br />$ 1,000,00 <br />P <br />X COMMERCIALGENERAL LABILITYX <br />CLAIMS -MADE OCCUR <br />X <br />PHPK2127804 <br />0510212020 <br />05/0212021 <br />PREMISES Ea ooc,mmoal <br />$ 100,00 <br />NED EXP(M ana person) <br />S 10,000 <br />A <br />X Prof. Liability <br />PHPK2127804 <br />05102/2020 <br />05102/2021 <br />PERSONAL& ADVINJURY <br />$ 1,000,00 <br />X <br />Sex AbuselMiscond <br />GENEILV. AGGREGATE <br />$ 2,000,00 <br />A <br />PHPK2127804 <br />0510212020 <br />05/0212021 <br />GEN, AGGREGATE <br />X POLICY <br />LIMIT APPLIES PER <br />M JFCTPRO- LOC <br />PRODUCTS - COMP/OP AGO <br />$ 2,000,00 <br />Dad: $0 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />J <br />ANY AUTO <br />X <br />X <br />PHPK2127804 <br />0510212020 <br />05102/2021 <br />COMBINED SINGLE LIMIT <br />Me a0dortl1,000,00( <br />BODILY INJURY (Par person) <br />$ <br />X <br />X <br />ALL OWNED SCHEDULED <br />AUTOS X AUTOS <br />HIREDAUT05 X NON -OWNED <br />AUTOS <br />� <br />./ <br />BODILY INJURY(Peracclenl) <br />S <br />PROPERTYD_AIDE T)) E <br />P RACC_ <br />$ 13I0,00 <br />ComplColl Dad. <br />$ 50 <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACHOCCURRENCE <br />$ 5,000.00 <br />AGGREGATE <br />$ 51000,00 <br />B <br />EXCESS LIAR <br />CWMS-MADE <br />X <br />X <br />PHUB720686 <br />0510212020 <br />05102/2021 <br />DELI I X I RETENTIONS 10000 <br />S <br />C <br />A <br />WORKERS COMPENSATION a/ <br />AND EMPLOYERS LIABILITYIM <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />OFFICEMEMBER <br />(Macla� In NH) <br />tt yos describe Under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />F1-WK-10000043-04 <br />(ACCIDENT) PHLY78928850 <br />02/08/20 0 <br />11P111�9 <br />02108�21 <br />11121/202000,00 <br />X KC STATU- X TH- <br />E.L. EACH ACCIDENT <br />E 1,000,00 <br />E.L.EDISEASE-EA EMPLOYE <br />q 1, <br />E.L. DISEASE -POLICY LIMIT <br />$ 11000100 <br />E <br />Cyber Liability ✓ <br />X <br />X <br />RPS AXIS P-077342120 <br />01/29/2020 <br />01/2912021 <br />Per Occ 1,000,00 <br />D <br />DAOI EPLI <br />X I <br />X <br />HSD7506508 <br />1211712019 <br />1211712020 <br />Aggregate 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101, Addldonal Remarks Schedule, R mar& apace la reeulrpe) <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 />orkes compensation waiver of subrogation included. 30 days notice of ✓ 0 O 2020 <br />cancellation for non-payment of premium. 4 <br />ANGLE ACFVEdO <br />CERTIFICATE HOLDER CANCELLATION <br />ATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana - <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, 4th Fir <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />t�-J <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />