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MERCY-2 OP ID: SD <br />'416% O CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) <br /> 05/111111/11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S) <br />AUTHORIZED <br />, <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER 714-369-2998 Stephanie Dufour <br />NA <br />E <br />Dufour Insurance Services <br />LLC M <br />: <br />, <br />5611 Littler Drive 714-840-6357 acNo Ext :714-369-2998 ac No : 714-840-6357 <br />Huntington Beach, CA 92649 <br />Stephanie Dufour E-MAIL <br />ADDRESS: Stephanie@dufourinsurance.com <br /> <br /> INSURER(S AFFORDING COVERAGE NAIC # <br /> INSURER A: Philadelphia Insurance Compani <br />INSURED Mercy House Transitional <br />Li <br />i <br />C <br />t INSURER B: Seabright Insurance Company <br />v <br />ng <br />en <br />ers <br />P.O. Box 1905 INSURER C : <br />Santa Ana, CA 92702 INSURER D : <br /> INSURER E : <br /> INSURER F : <br />COVERAGES CERTIFICATE NUMBER: RFvfclnN NI IwRI=R• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS <br /> <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY <br />PAID CLAIMS. , <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER POLICY EFF <br />1MMIDDNYYY) POLICY EXP <br />(MWDDfYYYY) <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY X PHPK714999 05102/11 05102112 PREMISES Ea occurrence $ 100,000 <br /> CLAIMS-MADE ? OCCUR MED EXP (Any one person) $ 5,00 <br />A X Professional PHPK714999 05102/11 05102/12 PERSONAL & ADV INJURY $ 1,000 <br />000 <br />A X Abuse - PHPK714999 05/02111 05/02112 GENERAL AGGREGATE $ , <br />2,000 <br />000 <br /> , <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 <br /> X POLICY PRO LOC $ <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />Eaacddent $ <br />1,000,000 <br />A ANY AUTO X PHPK714999 05/02/11 05/02112 BODILY INJURY (Per person) $ <br />X ALL OWNED X SCHEDULED <br />AUTOS AUTOS BODILY INJURY (Per accident) $ <br />X HIRED AUTOS X NON-OWNED <br />AUTOS PROPERTY DAMAGE <br />Per accident <br />X UMBRELLA LIAB X OCCUR <br />1,000,000 <br />A EXCESS LIAB CLAIMS-MADE X PHUB343841 05102111 0 1,000,000 <br />DED X RETENTION $ 10000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />B <br />ANY PROPRIETOR/PARTNER/EXECUTIVE r <br />BB1113517 02108/11 02/1 <br />OFFICERIMEMBER EXCLUDED? N/A <br />(Mandatory In NH) <br />yes, describe under <br />D <br />DESCRIPTION OF OPERATIONS below L <br />/ <br />A Professional Liabi X PHPK714999 05102/11 TV <br />051021 1 <br />000 <br />00 <br />A Abuse Liability X PHPK714999 05102/11 0510211 1 , <br />, <br />1,000,00 <br /> ®W <br />DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES [Attach ACORD 101, Additional Remarks Schedule, if more space is <br />Re: CDBG <br />ESG <br />d HPRP <br />t <br />Ci required) <br />, <br />, an <br />gran <br />s. <br />ty of Santa Ana its officers, employees, <br />a ents, volunteers and representatives are named additional insureds with (\.L <br />re act to the operations of the named insured & this policy is primary per <br /> <br />the attached endorsement. Workes compensation coverage excluded, evidence <br />onl <br />10 d <br />ti <br />f <br />- 5? ORGK <br />' <br />N <br />y. <br />ays no <br />ce o <br />cancellation for non-payment of premium. E' <br />rney <br />G <br /> Atto <br />W <br /> D <br />ista <br /> Ass <br />1 <br /> (b <br />I IVI\ <br />City of Santa Ana <br />Frank Hernandez <br />20 Civic Center Plaza Box 1988 <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />jkl <br />U I Vtft$-zUI U ACURD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD