COMMUNITY HEALTH INITIATIVE OF ORANGE COUNTY (2)

Home Browse Search

CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDP/YYY) 12/18/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT NAME: Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY, INC. PHONE Biz-266-695o A/C No : 585-389-7428 150 SAWGRASS DRIVE E-MAIL ceds@paychex.com ADDRESS: ROCHESTER, NY 14620 INSURERS AFFORDING COVERAGE NAICp INSURERA: STATE COMPENSATION INSURANCE FUND INSURED INSURER B INSURER C: Community Health Initiative of Orange County INSURER D: 1505 E 17Th St Suite 121 INSURER Ei Santa Ana, CA, 92705 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE ADDL JUM SU D POLICY NUMBER MM/ODY� POLICY LIMITS COMMERCIAL GENERAL LABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGES RE TED PREMISES(Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL a ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRO- JECT LOC OTHER: GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NOM WNED AUTOS ONLY AUTOS ONLY COMBINED SINGLELIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 9289091 11/051202011/05/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEAS E- POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD IO1, Additional Remarks Schedule, my be attached if more space is mqulmd) City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f qff.Jjl0q V*. ©1988.2016 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD w,.� RWeMAnngem"`DMs1bn REVIEWED &APPROVED BY: Risk Mat agernent Andlyst