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THOMAS HOUSE (3) - 2011
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THOMAS HOUSE (3) - 2011
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Last modified
3/14/2017 10:43:21 AM
Creation date
9/20/2011 4:02:13 PM
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Contracts
Company Name
THOMAS HOUSE
Contract #
A-2011-086
Agency
COMMUNITY DEVELOPMENT
Council Approval Date
3/21/2011
Expiration Date
6/30/2012
Insurance Exp Date
10/3/2011
Destruction Year
2017
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AC-ORD. CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MMIDDIYYYY) <br />THOMA -1 10/04/10 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />iblbll <br />LTR <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Huntington Pacific Ina. Agency <br />7901 Professional Circle <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW <br />Huntington Beach CA 92648 <br />POLICY EXPIRATION <br />DATE MWDDIYY <br />LIMITS <br />Phone: 714 -841 -6283 Fax: 714 -842 -2538 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A. Great American Insurance Co. <br />INSURER B: <br />$ 1,000 000 <br />A <br />Thomas House Temporary Shelter <br />P.O. BOX 2737 <br />Garden Grove CA 92842 -2737 <br />INSURERC: <br />PAC5603738 <br />1HSURERD <br />10/03/11 <br />INSURER 1= <br />$ 100,000 <br />MED EXP (Any ona person) <br />UUVLRA(3I;5 <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED I` LAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />iblbll <br />LTR <br />L <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />DATE MMIDDrYY <br />POLICY EXPIRATION <br />DATE MWDDIYY <br />LIMITS <br />GENERAL LIABILITY <br />EACHOCCURRENCE <br />$ 1,000 000 <br />A <br />X <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE O OCCUR <br />PAC5603738 <br />10/03/10 <br />10/03/11 <br />°PREMR10saEaoaurence) <br />$ 100,000 <br />MED EXP (Any ona person) <br />$5,000 <br />PERSONAL S ADV INJURY <br />$ 1 000 , 000 <br />_ <br />A <br />X <br />Sexual Misconduct <br />PACS603730 <br />10/03/10 <br />10/03/11 <br />CENERALAGCREOATE <br />s2 000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOPAGG <br />$ 1,000,000 <br />X POLICY PE LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE IRdR <br />(Ea acddenQ <br />$ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per person) <br />$ <br />HIItEOAUTOS <br />NON -OWNED AUTOS <br />•_ —. <br />BODILY INJURY <br />(Per accident) <br />__... .__. —___ <br />S <br />PROPERTYDAMAGE <br />(Par accldena <br />$ <br />.GARAGE LIABILITY <br />AUTO ONLY - EAACCIDENT <br />$ <br />ANY AUTO <br />OTHER THAN EA ACC <br />AUTO ONLY: AGO <br />S <br />$ <br />EXCESWUMBRELLA LIABILITY <br />OCCUR CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION $ <br />$ply O V Y� <br />FY y� <br />v <br />� <br />" <br />6O 0r <br />.•-- <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />_ <br />$ <br />T <br />$ <br />S <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTTVE <br />OFFK:ERIMEMBER EXCLUDED? <br />I1Iyyes AL PROVISONNS be$&N describeure!er <br />P E <br />AS Sjstan <br />L`l��i <br />I <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />EL. DISEASE- POLICYUI,IR- <br />$ <br />S <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT /SPECIAL PROVISIONS <br />The City of Santa Ana; it's officers, employees,agents,volunteers,and <br />representatives are named as additional insured in respects to the general <br />liability.This insurance is Primary and noncontributory per endorsement CG <br />92 24(ED.12 /OS)XS.This certificate supercedes any & all prior certificates <br />*10 Day Notice of Cancellation for non - payment of premium <br />t,CKI IriI,AIa nULUCK CANCLLLA IION <br />City of Santa Ana <br />Community Development Agency <br />Attn:Frank Hernandez <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />25 <br />CITSAAA I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC <br />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 />
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