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MERCY HOUSE LIVING CENTERS (ESG 2010) (2)
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MERCY HOUSE LIVING CENTERS (ESG 2010) (2)
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Last modified
3/23/2017 1:56:21 PM
Creation date
8/18/2010 3:51:59 PM
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Contracts
Company Name
MERCY HOUSE- EMERGENCY SHELTER
Contract #
A-2010-061-006
Agency
COMMUNITY DEVELOPMENT
Council Approval Date
4/5/2010
Expiration Date
6/30/2011
Insurance Exp Date
5/2/2011
Destruction Year
2016
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CERTIFICATE OF LIABILITY INSURANCE OP ID PC DATE(MMND/YYYY) <br />ANY REQUIREMENT, TERM OR CONDITON OF ANYCONTRACT OR OTHER DOCUME14T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MERCY -2 07/01/10 <br />PRODUCER <br />LTR <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Chapman <br />POLICYNUMSER <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License 10522024 <br />LIMITS <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. 0. Box 5455 <br />GENERAL LIABILRY <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Pasadena CA 91117 -0455 <br />EACH OCCURRENCE <br />S 1,000,000 <br />Phones 626 -405 -8031 Fax s 626 -405 -0585 <br />X <br />INSURERS AFFORDING COVERAGE <br />NAIC N <br />INSURED <br />05/02/11 <br />INSURERA: Philadelphia Insurance company <br />23850 <br />MED EXP (Any one person) <br />$ 5,000 <br />INSURER B: Everest National <br />- <br />10120 <br />Mercy Hou Q <br />T ?05 <br />-....---- ....... <br />INSURER C: <br />- -. <br />P.O. Box <br />Santa Ana CA 92702 <br />D., <br />INSURER D: <br />GENERALAG13REGATE <br />S 2 f 000, 000 <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAAIED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITON OF ANYCONTRACT OR OTHER DOCUME14T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. <br />LTR <br />SRQ <br />TYPE OF INSURANCE <br />POLICYNUMSER <br />DATE D <br />D LI M ADD <br />LIMITS <br />GENERAL LIABILRY <br />EACH OCCURRENCE <br />S 1,000,000 <br />A <br />X <br />X COMMERCIAL GENERAL UABILTTY <br />CLAIMS MADE X❑ OCCUR <br />PHPK562497 <br />05/02/10 <br />05/02/11 <br />PREMISES eoccurence <br />S 100r000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />_ <br />GENERALAG13REGATE <br />S 2 f 000, 000 <br />GEN'I AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OPAGG <br />52,000,000 <br />POLICY PRO, LOO <br />JECT <br />— —' <br />A <br />AUTOMOBILE <br />X <br />LIABARY <br />ANY AUTO <br />PHPK562497 <br />*.%02'/10 <br />0 /02/11 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1000000 <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON•OW14EDAUTOS <br />QgO <br />air <br />S'C�a <br />S C'M p` <br />ey <br />-- <br />s <br />BODILY INJURY <br />(Par parson) <br />BODILY INJURY <br />(Peraccident) <br />S <br />to <br />A59� <br />PROPERTY DAMAGE <br />(Per ecddenq <br />$ <br />GARAGE LIABILITY <br />AUTO ONLY • EA ACCIDENT <br />$ <br />ANY AUTO <br />EA ACC <br />OTHER THAN ___. <br />AUTO ONLY: AGO <br />$ <br />$ <br />A <br />EXCESSI UMBRELLA LIABILITY <br />X OCCUR CLAIMS MADE <br />PHUB305872 <br />05/02/10 <br />05/02/11 <br />EACH OCCURRENCE <br />$1000000 <br />AGGREGATE <br />_ <br />S1000000 <br />DEDUCTIBLE <br />0 <br />$ <br />X RETENTION $10000 <br />S <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILIT Y <br />ANY PROPRIETOFUPARTNERIEXECUTIV4Y�� <br />OFFICERIMEMBER EXCLUDE I? L_ I <br />(Mandatory In NH) <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />6600000730091 <br />10/01/09 <br />10/01/10 <br />X TORY LIMIT S <br />E.L.EACHACCIDENT <br />__...._._.__._..__..__ <br />$ 000000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1000000 <br />E.L. DISEASE -POLICY LIMIT <br />$1000000 <br />OTHER <br />A <br />D &O <br />PHSD454501 <br />10/17/09 <br />10/17/10 <br />Limit 1000000 <br />Dad. 2500 <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES( EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Re: CDBO, ESO, and HPRP grants. City of Santa Ana, its officers, employees, <br />agents, volunteers and representatives are named additional insureds with <br />respect to the operations of the named insured & this policy is primary per <br />the attached endorsement. Workes compensation coverage excluded, evidence <br />only, 10 days notice of cancellation for non - payment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Frank Hernandez <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />:Santa Ana, CA 92702 <br />ACORD 25 (2009/01) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />CITYSAN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />I7I <br />Fx <br />The ACORD name and logo are registered marks of ACORD <br />All rinhis reserved <br />
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