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AC Dr. CERTIFICATE OF LIABILITY INSURANCE 0�/2�/2005 Y' PRODUCER Schweickert & Company THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 15 Peters Canyon Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Irvine CA 92606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Mercy House INSURER A Great American Insurance Company P.O. Box 1905 INSURER B Santa Ana CA 92702 _INSURER C i INSURER D INRI IRFR F OVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADD' TR TvPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS I,000,000 GENERALCOMMERCIAL PAC5373885 05/02/2005 05/02/2006 _ $ X X 1 DACH MAGE TO DAMAGE TO RENTED 100 000 GENERAL _- Sex Abuse Aggregate limit is PREMISES Ea ocnue ffiL __ $ J CLAIMS MADE OCCUR $1,000,000 MED PXP (f.n� one Fe•son; $ 5.000 _ _ X ProfesslDnaILiability FPERSONAL 'AV INJURY $ I,000,000 - X AbUSe & Molestation No deductible or SIR �. 2,000:000 GENERAL AGGREGATE _ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: -- PRODUCTS-COMPIOP AGG $ X' POLICY PRO- LOC AUTOMOBILE LIABILITY PAC5373885 05/02/2005 05/02/2006 COMBINED SINGLE LIMIT $ 1 000 �� ANY AUTO (Ea accident) ALL OWNED AUTOS I BODILY INJURY $ SCHEDULEDAUTOS (Per person) A X X HIRED AUTOS BODILY INJURY $ j( A X NON -OWNED AUTOS (Per ace dent) ---..---_— PROPERTY DAMAGE $ (Per accident) i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT_ IS _ _{ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE I DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND r, n D , )°,(Lil ,o t ° , �:'_.... WC STATU OTH- _11JDRYIIN[TC_ - _ EMPLOYERS' LIABILITY' L' El EACH ACCIDENT ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? yJ/ ✓J �/ L,�+ /v E L DISEASE EA EMPLOYEEI $ 1/ es, tlesaibe untler iL --j S below E.L. DISEASE - POLICY LIMIT $ OTNER i_.l L.ki. - I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Santa Ana, its officials, employees, representatives, and volunteers are hereby named as Additional Insureds as respects the operations of or on behalf on Mercy House Transitional Living Center, performed [coder contract with The City of Santa Ana. CFRTIFICATF HOI nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOJt6 THE EXPIRATION City of Santa Ana DATE THEREOF, THE ISSUING INSURER MLEMNUEAVOR70 MAIL SS DAYS WRITTEN 20 Civic Center Plaza NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT; SDTTAILIIRETO.OUSU SMALL PO Box 1988 -IMPME-NU-OHL'IGATIOWURZMMl OF-ANYI D-OPON-THEINSORER,,- B-AC,ENTS OR -REPRESENTATP/hS. Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE et� ACORD 25 (2001108) ('pD ACORD CORPORATION 1988