FAMILIES TOGETHER OF ORANGE COUNTY (3)

Home Browse Search

t Digitally signed by Francine R. Francine R. Villareal'Ylla,eal Date: 021.oa.lo 1112:03 07DY AC �® CERTIFICATE OF LIABILITY INSURANCE DA'E(MMIDD z11 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 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(les) must 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 endorsement(s). PRODUCER�CJOOT AME: Sandra COX PHCNo (714)263-3600 - AIX No: l719l263-3600 Lake Insurance Agency 653 South B Street E-MAIL sandra@lakeins.com ADDRESS: L1C #0747473 INSURERS AFFORDING COVERAGE NAIC0 INSURERA: The Hanover Insurance Company 22292 Tustin CA 92780 INSURED INSURERS: Employers Preferred Insurance Company 10346 INSURERC: Families Together of Orange County 661 W. let, #G INSURER D: INSURERE: Tustin CA 92780 INSURER F: COVERAGES CERTIFICATE NUMBER:20-21 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR LTR rypE OF ADDL SUER POLICY NUMBER POLICY EFF MIDDIYYYY) POLICY EXP IMMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIM&MADE FxI OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Es occurrence $ 1, 000,000 MED EXP(Any one person) $ 10,000 X Z13I11106741102 11/6/2020 11/6/2021 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY ❑ jE�a LOG PRODUCTS-COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000, 000 X BODILY INJURY (Per person) $ A AWAUTO ALL OWNED SCHEDULED AUTOS AUTOS AWIB099975 11/6/2020 11/6/2021 BODILY INJURY (Per accldenl) $ HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000 000 AGGREGATE $ 4.000 000 A EXCESS LIAS CLAIMS -MADE DELI I X I RETENTION $ 10,000 $ MIH423239 11/6/2020 11/6/2021 WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN X PER OTH- STATUTE ER E,L. EACH ACCIDENT $ . 11000,000 B ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERIMEMSER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under NIA EIG250255304 5/16/2021 5/16/2022 E.L. DISEASE-EAEMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICYLIMIT $ 1 OLIO 000 DESCRIPTION OF OPERATIONS LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more apace Is required) The City of Santa Ana, its Officers, Agents Employees and Representatives are Additional Insured as respects general liability per CG 20 26 04 13. Coverage is primary and noncontributory per endorsement 421-2915 06 15. CERTIFICATE HOLDER CANCELLATION The 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 ie Toby/SANDRA ACORD 25 (2014101) INS025 (201401) The ACORD name and logo are registered marks of ACORD