Laserfiche WebLink
Francine R. 1111111yalanm by <br />Fawdre R. Villareal <br />Villareal _r"202tm.z9 1a;1652 Page 1 of 2 <br />CERTIFICATE OF LIABILITY INSURANCE <br />O05/21ATE I/2021Y) <br />05/21/2021 <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 poilcy(les) 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 />Willis (Bermuda) Ltd. <br />Wellesley souse, 2nd Floor <br />90 Pitts Hay Road <br />CONTACT Willie Towers Watecn Certificate Center <br />NAME: <br />qIC No; 1-888-467-2378 <br />R.E.-877-995-7378 <br />ApD Ecertificates@willis.com <br />INSURERS AFFORDING COVERAGE <br />NAICA <br />Pembroke, MOB END <br />INSURER A: American Unity Group Limited <br />C0929 <br />INSURED <br />Taller San Jose Hope Builders <br />INSURER B: <br />801 N. Broadway <br />INSURER C: <br />INSURERD: <br />Santa Ana, CA 92701 <br />INSURERE: <br />NSURERF: <br />COVERAGES CERTIFICATE NUMBER: W21008985 RFVISION NIIMRFP- <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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRADDLSUBR <br />LTft <br />TYPE OF INSURANCE <br />JHM <br />WVD <br />POLICYNUMBER <br />OUCYYFF <br />POLIC EXP <br />LIMITS <br />X <br />COMMERCIALGENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 3,000,000 <br />X CLAIMS -MADE OCCUR <br />DAMAGE TO RE TED <br />PREMISES Ea occunenoe <br />$ <br />MED EXP (Any one erson) <br />$ <br />A <br />y <br />1-14601-00-21 <br />06/01/2021 <br />06/01/2022 <br />PERSONAL &ADV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$ 5,000,000 <br />K POLICY PRO- <br />JECT ❑ LOC <br />PRODUCTS - COMP/OP AGO <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea eccldenl <br />$ <br />BODILY INJURY (Par Person) <br />$ <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Par accident) <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accldent <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />OF ICERIMEMS REXCLUDED?ANYPROPRIETORIPARTNEWEXECUTIVE ❑ <br />NIA <br />E.L. DISEASE EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If year dsacrlba 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, maybe attached if more space is requlred) <br />If this Certificate of Insurance is for Professional and / or General Liability insurance this provides evidence of <br />coverage for 1) amployeas while acting within the scope and during the course of their employment with Providence St. <br />Joseph Health and /or 2) contracted parties for their acts, errors or omissions in rendering or failing to render <br />Medical Services outlined by such contract with a Providence St. Joseph Health entity including the Insured identified <br />on this certificate. <br />HOLDER <br />City of Sans. Ana Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, 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 />JS_ <br />©1988.2016 AC <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />Sa In: 21126221 BATON: 2103724 <br />r RielrManagznlerdffivislon , <br />$/'(r*IVs� <br />REVIEWED & APtPRCVM BY. <br />E( /19Yll1Yr9adHl.+vF+d <br />Ruk ManageementAnalyst <br />