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CASA DE LA FAMILIA (4)
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CASA DE LA FAMILIA (4)
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Last modified
7/11/2022 10:11:48 AM
Creation date
6/30/2022 10:41:13 AM
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Contracts
Company Name
CASA DE LA FAMILIA
Contract #
A-2022-104
Agency
Police
Council Approval Date
6/21/2022
Expiration Date
6/30/2025
Insurance Exp Date
3/23/2023
Destruction Year
2030
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<br />Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! <br />Upsj!Qjfstpo <br />Ebuf;!3133/17/3:!25;24;31!.18(11( <br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />05/31/2022 <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 policy(ies) 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 />CONTACT <br />PRODUCER Renee M. Fazeli <br />NAME: <br />FAX <br />PHONE <br />The Liberty Company Insurance Brokers(888)918-3960(866)835-9829 <br />(A/C, No): <br />(A/C, No, Ext): <br />E-MAIL <br />Lic #0D79653rfazeli@libertycompany.com <br />ADDRESS: <br />5955 De Soto Ave, Suite 250 <br />INSURER(S) AFFORDING COVERAGENAIC # <br />Woodland HillsCA91367Philadelphia Indemnity Insurance Company18058 <br />INSURER A : <br />INSURED State Compensation Insurance Fund35076 <br />INSURER B : <br />Casa de la FamiliaHSB Specialty Insurance Company14438 <br />INSURER C : <br />1650 E 4th Street <br />INSURER D : <br />INSURER E : <br />Santa AnaCA92701 <br />INSURER F : <br />22/23 <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <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 />ADDLSUBR <br />INSRPOLICY EFFPOLICY EXP <br />TYPE OF INSURANCELIMITS <br />POLICY NUMBER <br />LTR(MM/DD/YYYY)(MM/DD/YYYY) <br />INSDWVD <br />COMMERCIAL GENERAL LIABILITY 1,000,000 <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />100,000 <br />CLAIMS-MADEOCCUR$ <br />PREMISES (Ea occurrence) <br />5,000 <br />MED EXP (Any one person)$ <br />AYNPHPK241124705/06/202203/23/20231,000,000 <br />PERSONAL & ADV INJURY$ <br />3,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO- <br />3,000,000 <br />POLICYLOCPRODUCTS - COMP/OP AGG$ <br />JECT <br />Professional Liability1,000,000 <br />$ <br />OTHER: <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY 1,000,000 <br />$ <br />(Ea accident) <br />ANY AUTOBODILY INJURY (Per person)$ <br />OWNEDSCHEDULED <br />ANNPHPK241124705/06/202203/23/2023 <br />BODILY INJURY (Per accident)$ <br />AUTOS ONLYAUTOS <br />HIREDNON-OWNEDPROPERTY DAMAGE <br />$ <br />(Per accident) <br />AUTOS ONLYAUTOS ONLY <br />$ <br />UMBRELLA LIAB <br />OCCUREACH OCCURRENCE$ <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />DEDRETENTION$$ <br />PEROTH- <br />WORKERS COMPENSATION <br />STATUTEER <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />BN N / A N92483182203/23/202203/23/2023 <br />OFFICER/MEMBER EXCLUDED? <br />1,000,000 <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />1,000,000 <br />DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ <br />Aggregate$1,000,000 <br />Cyber Risk* <br />C66275770105/06/202203/23/2023Retention$5,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Where required by written contract or agreement, City of Santa Ana, officers, agents, employees, and volunteers are Additional Insured on a Primary and <br />Non-Contributory basis to the extent provided in the attached forms. <br />CERTIFICATE HOLDERCANCELLATION <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 />City of Santa Ana <br />Risk Management Division <br />AUTHORIZED REPRESENTATIVE <br />20 Civic Center Plaza <br />Santa AnaCA92702 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br /> <br />
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