MERCY HOUSE LIVING CENTERS (CDBG 2007) T

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From: Jessism Raya-Ellis At: Chapman & Associates F"D: Chapman Associates To: Laura Sheedy Date: 7/23/2007 11:35 AM Page: 2 of 4 OP ID DATE (MM/OD/YYYY) ACQRv CERTIFICATE OF LIABILITY INSURANCE MERCY_2 07 23/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chapman & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0522024 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 5455 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91117-0455 Phone: 626-405-8031 Fax:626-405-0585 INSURERS AFFORDING COVERAGE NAIC # INSURED �f A-2007-105-25 INSHRERA Philadelphia Insurance CoMany INSURER B. A X Mercy House P.O. Box 1905 Santa Ana CA 92702 NSURER C NSLIRERD NSURER E. PREMISES (Eaoccurence) $ 100,000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING C 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER ATE MMDD DATE MXWDD PIRATI N LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X X CC+MMERCIALGENERAL LIABILITY PHPK231259 05/02/07 05/02/08 PREMISES (Eaoccurence) $ 100,000 CLAIMS MODE a OCCUR MED EXP IAny one person) $5,000 X Professional PERSONAL 8 ADV INJURY $ 3L,000 '000 2mi1 agg/lmil OCC GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 17 POLICY PE0. 1-1 LOC AUTOMOBILE LIABILITY A ANY AUTO PHPK231259 05/02/07 05/02/08 COMBINED SINGLE LIMIT $ 1000000 (Ea accident) ALL OW NE D AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Perecwdent) PROPERTY DAMAGE $ -- (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY ,+-� VC RM EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE ¢ DEDUCTIBLE I $ RETENTION $ _ $ i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY iir`d. -Lt y Ci Atter>l� TOIL ITATU RY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE As51St3 OFF CER/MEMBER EXCLUDED% E.L. DISEASE - EA EMPLOYEE $ If yes. d--nhv under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS be!— OTHER A Sexual Abuse PHPK231259 05/02/07 05/02/08 Aggregate 300,000 ea Abuse 100,000 DESCRIPTION OF OPERATIONS /LOCATIONS !VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS Re: CDBG and ESO grants. City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insureds With respect to the operations of the named insured & this policy is primary per the attached Exhibit B endorsement. 10 days notice of cancellation for non-payment of premium. ERTIFICAI r HOLDER CAMCELLATION City of Santa Ana Frank Hernandez 20 Civic Center Plaza P.O. Box 1988 Santa Ana CA 92702 1108) CITYSAN I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.