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FAMILIES TOGETHER OF ORANGE COUNTY (5)
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FAMILIES TOGETHER OF ORANGE COUNTY (5)
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Last modified
4/28/2022 9:23:50 AM
Creation date
4/7/2022 2:38:11 PM
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Contracts
Company Name
FAMILIES TOGETHER OF ORANGE COUNTY
Contract #
A-2021-107-04B
Agency
Community Development
Council Approval Date
7/6/2021
Expiration Date
9/30/2022
Insurance Exp Date
1/1/1900
Destruction Year
2027
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A-2021-107-04B <br />e Digitally signed by Framine R. <br />Francine R. Villareal"mgla,aM <br />66ie: 2021n. In 1111.1 <br />ACO/ZO CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMID2[NYYY) <br />�� <br />7/z7/2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTER 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 policy(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 endorsement(s). <br />PRODUCER <br />NAME Sandra Cox <br />Lake Insurance Agency <br />653 South B Street <br />PNCN o Ed(714)263-3600 - qlc No: 17141263-ss09 <br />EMAIL ADDRESS• Sandra@lakeins.com <br />L1C #0747473 <br />INSURERS AFFORDING COVERAGE <br />NAIC N <br />INSURERA: The Hanover Insurance Company <br />22292 <br />Tustin CA 92780 <br />INSURED <br />INSURERB:Em lorex2 Preferred Insurance Company <br />10346 <br />INSURERC: <br />Families Together of Orange County <br />661 W. 1st, kG <br />INSURERD: <br />INSURER E: <br />Tustin CA 92780 <br />INSURERF: <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 OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br />CERTIFICATE MAYBE 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 />INSR <br />R <br />TYPE OF INSURANCE <br />AODL <br />BUBB <br />POLICYNUMBER <br />POLICYEFF <br />MMIDOlY=XI <br />POLICYEXP <br />(MMIDONYYYI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIM&MADE ❑X OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occunebca <br />$ 1,000, 000 <br />MED EXP (Any one person) <br />$ 10,000 <br />X <br />ZDIR10874802 <br />11/6/2020 <br />11/6/2021 <br />PERSONAL &ADV INJURY <br />$ 11000,000 <br />GEN'LAGGREOATE LIMITAPPLIES PER: <br />X POLICY ❑ JPEC LOC <br />GENERALAGGREGATE <br />$ 2,000,000 <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE -LIMIT <br />Ea ...Went)_ <br />$ 1,000,000 <br />X <br />Per person) <br />BODILY INJURY '(I'., <br />$ <br />A <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />AWIH099975 <br />11/6/2020 <br />11/6/2021 <br />BODILY INJURY P ,abcldenq <br />( e <br />$ <br />NON-0WMED <br />HIRED AUTOS AUTOS <br />PROPERTYOAMAGE <br />Per ascidpar <br />$ <br />$ <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 4 000,000 <br />AGGREGATE <br />$ 4,000,000 <br />A <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED X RETENTION $ 10 000 <br />URIH423239 <br />11/6/2020 <br />11/6/2021 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />if . 1.000,000 <br />B <br />ANY PROPRIETORJPARTNERIEXECUTNE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />NIA <br />SI0250255304 <br />5/16/2021 <br />5/16/2022 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 11000,000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1, 000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remark. Schedule, may be attached if more space is required) <br />The City of Santa Ana, its Officers, Agents Employees and Representatives are Additional Insured as <br />respects general liability per CG 20 26 04 13. Coverage is primary and noncontributory per endorsement <br />421-2915 06 15. <br />L.rn I IrIL.AI C nVLUMM <br />The City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />ACORD 25 (2014101) <br />INS025 (201401) <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 />ie Toby/SANDRA <br />The ACORD name and logo are registered marks of ACORD <br />Rielc MuerlEDtvlatml <br />pREVIEWED kIAgPPROVED BY: <br />i� R1sk NlaRagement AnalysE.s <br />
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