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ORANGE COUNTY MENTAL HEALTH ASSOCIATES 1
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ORANGE COUNTY MENTAL HEALTH ASSOCIATES 1
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Last modified
8/23/2021 2:48:44 PM
Creation date
11/24/2004 2:10:17 PM
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Contracts
Company Name
Mental Health Association
Contract #
A-2004-043
Agency
Community Development
Council Approval Date
3/15/2004
Expiration Date
6/30/2005
Insurance Exp Date
7/12/2006
Destruction Year
2010
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ACORD. CERTIFICATE OF LIABILITY INSURANCE <br />olio jzoo <br />PRODUCER (949) 709-8800 FAX (949) 709-1668 <br />Comprehensive Insurance Services <br />22342 Avenida Empresa <br />Suite 200 <br />RSM, CA 92688 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />Mental Health Association of Orange County <br />822 Town & Country Rd. <br />Orange, CA 92668 <br />INSURERA: NONPROFITS' INSURANCE ALLIANCE OF <br />CA <br />INSURER B: <br />INSURER C: - <br />INSURERD: <br />INSURER E: <br />GFR <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />ADD-1 <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATKINITR <br />LIMITS <br />GENERAL UABILRY <br />2004-08472—NPO <br />07/12/2004 <br />07/12/2005 <br />EACHOCCURRENCE <br />$ 1,000,00 <br />X COMMERCIALGENERALLIABILITY <br />DAMAGE TO RENTED <br />$ 100,00 <br />A <br />CLAIMS MADE MOCCUR <br />$ 10,00 <br />MED EXP(Any one perms) <br />PERSONAL BADVINJURY <br />$ 1,000,0001 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OPAGG <br />$ 2,000,00 <br />POLICY JET X LOC <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />2004-08472-NPO <br />07/12/2004 <br />07/12/2005 <br />COMBINED <br />(Ee ecdtl MSINGLE LIMIT <br />$ 1,000,00 <br />BODILY INJURY <br />(Per Perron) <br />$ <br />A <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per acc ) <br />$ <br />HIREDAUTOS <br />NON-0WNED AUTOS <br />PROPERTY DAMAGE <br />(Per aWdC nl) <br />$ <br />GARAGE LIABILITY <br />- <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />OTHER THAN EA ACC <br />E <br />AUTO ONLY: AGO <br />$ <br />EXCESSAIMBRELLA LIABILITY <br />X OCCUR F-ICLAIMS MADE <br />2004-08472-UMB-NPO <br />07/12/2004 <br />07/12/2005 <br />EACHOCCIIRRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,00 <br />A <br />$ <br />DEDUCTIBLE <br />E <br />X RETENTION $ 10,00( <br />$ <br />WORKERS COMPENSATION AND <br />_ <br />WC STATII OTF4 <br />EMPLOYERS' LIABILITY <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />If yes, Ees k* antler <br />E.L. DISEASE - EA EMPLOYE <br />E <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />SPECIALPROVISIONSWm <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />ERTIFICATE HOLDER IS NAMED AS ADDITIONAL PER ATTACHED SPECIAL ENDORSEMENT EXHIBIT B <br />EXCEPT 10 DAYS FOR NON-PAYMENT <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL*)aiXao.S 1MAIL <br />EMPLOYEES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />ATTN: DORIS TURLEY XNXNXdU�>�1IL�i(XXii)<30NDH6YT1EXifdN0N4XA`�1(IfXXX: <br />20 CIVIC CENTER PLAZA, M-25 NX**Xmyj)(*XxB maK*M&XY60900waikuymXXXXXXXX: <br />SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE <br />_ Richard Eynon, CIC/JEREMY 4�1_ <br />ACUKU 20 (ZUU1108) ©ACORD CORPORATION 1988 <br />
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