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OP ID PC C-0- 0. CERTIFICATE OF LIABILITY INSURANCE MERCY-2 DATE pdM/DDNYYY) 05/05/09 PRODUCER Chapman License #0522024 P. 0. Box 5455 Pasadena CA 91117-0455 Phones 626-405-8031 Fax :626-405-0585 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED Mercy House P.O. BOX 1905 Santa Ana CA 92702 INSURERA: Philadelphia Insurance company INSURERS: Everest National INSURERC. INSURER D: INSURER E: 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. N'RwILTR NSfl TYPE OF INSURANCE POLICY NUMBER DATE AMrDD D 7E p — — LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Eaoaxuence $ 100 000 A X X COMMERCIAL GENERAL LIABILITY PHPK309978 05/02/09 05/02/10 CLAIMS MADE ❑X OCCUR LIED EXP (Anyone person) $ 5 , 000 PERSONAL& ADV INJURY $ 1 000 000 X Professional NO DEDUCTIBLE 2mil agcL/lmil occ GENERALAGGREGATE s2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMPjOPAGG S 2,000,000 X I POLICY ITT LOC A AUTOMOBILE LIASIL ITY X ANYAUTO PHPK309978 05/02/09 05/02/10 COMBINED SINGLE LIMIT (Eaamldeng $1000000 BODsLY INJURY (Perpereon) $ ALL OWNED AUTOS SCHEDULEDAUTOS NO DEDUCTIBLE 130DILYINJJRY (Per ecddera) $ X HIREDAUTOS X NON-OWNEDAUTOS PROPERTYDAMAGE (Per axidenl) $ GARAGE LIABILITY APPROVED AS TO POIRIM AUTO ONLY -EAACGOENT s OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO � ` $ EXCESSNMBRELLAUABIUTY EACH OCCURRENCE S OCCUR CLAIMSMADE Lafua Sti Shf'fi y AGGREGATE $ Assist ity Atto •ney $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEWEXECUTNE OFFICER/MEMBEREXCLUDED? I1 yyeess, desabe under SPECIALPROVISIONS befaa 6600000730081 NO DEDUCTIBLE 10/01/08 la/ol/os X TORYUMffS ER E.LEACH ACCIDENT $l000000 E.L. DISEASE• EA EMPLOYE $ 1000000 E.L.DISEASE-POLrYLlhIff s 1000000 OTHER A Sexual Abuse PHPK309978 05/02/09 05/02/10 Aggregate 1,000,000 NO DEDUCTIBLE ea Abuse 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEIAENT/ SPECIAL PROVISIONS Res CDBG and ESG 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 endorsement. Workes compensation coverage excluded, evidence only. 10 days notice of cancellation for non-payment of premium. GEHTIFICATE HOLDER CANCELLATION City of Santa Ana Frank Hernandez 20 Civic Center Plaza P.O. Box 1988 Santa Ana CA 92702 CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATH 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 $O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 25 ® ACORD CORPORA yj --zo ,?A- / �"' f-