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w <br />ACORD CERTIFICATE OF LIABILITY INSURANCE OPIDPC DATE IMN/DDM'Y1~ <br /> MERCY 2 05/09/08 <br />~DpB~Ep THIS CERTIF{GATE IS ISSUED AS A MATTER OF INFORMATION <br />Chapman & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License Y0522024 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. o. sox 5455 <br />177 <br />U8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />' <br />Pasadena CA 91117-0455 A'2U <br />Phone: 626-405-8031 Fax 626-405-0585 <br />IN8URE0 ~' INSURERS AFFORDING COVERAGE ' NAIC # <br /> INSUiEIiA F 1 FLL. ]~ Gay. <br />pSUR9iB Everest National ' <br /> <br />_ ._ <br />I ----- _ L_ _ -- <br /> <br />Mercy House I INBUPER G <br />I _.. .. ... _... _. ... .. .. .I __._._ __. <br />P.O. Box 1905 INS <br />RwQ <br />Santa Ana CA 92702 ~ <br />_ ... __ . _ _. _ __ . __ _ __ <br />_ - -- . <br />INSURER E <br />LU V tFiAlat.S <br />THE POLICE80F INSURANCE uSTEO BELOW HAVE BEFN IBSLEO TO THE INBURED NAMED ABOVE FOR THE PG1CY PETiIOD INDIGTEO. NOTYATH6TAIOING <br />AM gC-0UIFB.IEM, TERM OR UJNDRION OF ANY CONTRACT OR OTIi_R DOGIMEM WITH RESPECT TO VANCM TYiB CERTIflGTE NAV BE 158UED CR <br />AMY F'ERTNµ TFE IFEtUPANCE AFFORpED BV THE PGJCES Of50RIBED FEREIN 6 ELBIECT TO ALL TFE TEPMB, EXQ.IENONS PND CCNpTONS of SUCH <br />POUGES. AGGPEGTE LIMRB SHOVVTN MAV HAVE BEEN R®UCED BY PND GJJA£ <br />INSR ADO'L - ..POLICY EFFECTIVE ~ POLICY EXPIRATgN <br />LTR {NBRD I TYPE OF INBURANCE POLICY NVYBEp PATE IMMNDlYVI i OATE (NI.VDDlWJ UMITB <br />GENEMLLIABILfTV I PACK OCCIRiENCE i 1,000,000 <br />A i R I X GYAMERCIALG]JERALLAEVUTV <br />~ PHPK309978 ~ 05/02/08 I 05/02/09 . ~~ p~ ~ ~ s 100 <br />000 <br />_ <br />~ I ~', ! GaMEMADE X I oocLSl i ~ ~ MEDExP(Nna+vaau , <br />I F 5,000 <br />X ~ Ps'Ofessionai ~ i ~. ~ PPisonwLanwlwlyrv I t 1 G00,000 <br />12mi1 a <br />/lmil occ i I <br />qg ~C>EN6MLAGCAEGATE ~s 2 000,000 <br />: ': GENL AGGF~GTE 4AYT APRJ6 P9L' <br />I PROwcrs.coAproPACG <br />! s 2 <br />000 <br />000 <br />__...1 r.... PRO __ <br />~ , <br />, <br />~ POLICY I JECi j I.OC <br />' AUTOMOBILE LIABILITY : ~ <br />'i CCMBIN®81NOLE UMR S lOOOOOO <br />A ~ ANYAUro ~ PHPK309978 05/02/08 i 05/02/09 I (EA.oeuaD <br /> <br />' '. ~ KL ONNEO AUTOS I _ __-- - <br />:.. ~ ' <br />~ <br />' BDDILYIWLFIV <br />s <br />~ scH®IxEDAUres I <br />' <br />i IFwPPlsmr <br />$ ': HNED AUTOS I <br />~ <br />, LVJGIYIWUM <br />R i NJNON?EO AUTOS ~ (P. anUvR i <br /> <br />~ _. j <br />_ _ I <br /> <br /> <br />I i <br />'. ;IPM seEelq <br />GRAGE LMBILITY ~ , <br />_.. ~ AuT00tLY-E4 AG:IOEM <br />_____..__.. _....__._ ... f <br />... _._...._ ._ <br />' <br />I i <br />ANY AVTO ~ <br />I i <br />I <br />OTHER THAN EA ACC i <br />_ {.. <br />I i AUTO ONLY: <br />AGG S <br />' EYCE68NMBRELLA LIABILITY <br />_ i '~ 'I <br />EAG1 OLCI.flRENCE <br />S <br />' <br />I ~'~ AMDE I <br />~~ ( ~ AGC~iEGATE S <br />__ _. _ <br />I <br />'i. ~ _. __ ...._._ I . f... -. __. _._. _. _ <br />DEDUCTI&E ' <br />1 _ I I f <br /> <br />RETENTION i <br />I f <br />, <br />WORKERa COMPENBATN]N AND I X ' we srAru. <br />TOM LIMITB 0TH <br />ER <br />' EYPLOYF%'LIABIUTV I <br />$ 660oooo7soon l0/01/07 to/ol/os <br />ELEAGIACGOEM <br />~ f looooo0 <br />ANY PRDPRIETORPARTNER~IXEGlTIVE <br />~ <br />OFFlCBiMENBER FXCUAED? ~ <br />I <br />~ CL. G8EA8E-FiA E#IPLOVEE I S lOOOOOO <br />nv®.~criw x~m. <br />; ,. <br />~ <br />BPEGAL PRwnBiON$ LRloii - '. EL. GSEASE ~ POLK;Y uMT ' <br />S 1 OOOOOO <br />OTHER - <br />A i Sexual Abuse ! PHPK309978 05/02/08 05/02/09 <br />I I , <br />hggregate 300,000 <br />I 1 j ea Abuse 100,000 <br />DESCRIPTION M OPEAATNJNS / LOCATN)NB / VEHICLES lEXCLUSIONB AOOED BY EN0016 FMENT / 6PECIAL PROV1810N8 <br />Re: CDBG and ESG grants. Citp of Santa Ana, its officers, employees, agents, <br />volunteers and representatives are named additional insureds with respect <br />to the operations of the named insured a this policy is primary per the <br />attached endorsement. Workes compensation coverage excluded, evidence only. <br />10 days notice of cancellation for non-payment of premium. <br />CITYSAN <br />City of Santa Ana <br />Frank Hernandez••, ~ - r„~_, <br />20 Civic Center Plaza <br />P.O. sox 1988 <br />Santa Ana CA 92702 <br />_ _ _ C~v~~~ / _3.. _ .. <br />ACORD 25 (2001/08) =--- <br />I:ANI:tLLA 1 I VN <br />SHOULD ANV OF THE ABOVE pFBCiNBFD POLICIES BE GMLELLED BEFORE THE EXPIRATN)N <br />GATE THEREOF, TNEIBBUING INSURER WILL ENDEAVOR TO NNL .1O DAVS WRITTEN <br />NOTICE TO THE CERRFIGTE MOLDER NAMED TD 1HE LEFT, BUT FNLURE TO DO 80 SMALL <br />IMPOSE NO OBLJGTN)N OR UA&UTY OF ANY KIMD UPON ME INBUpER ITS AGENTE OR <br />RERIEBENTATNEB. <br />D CORPORATION 1988 <br />