OLIVE CREST 1E - Laserfiche WebLink

Home Browse Search

Client#: 28768 20LIVCRE ACORM CERTIFICATE OF LIABILITY INSURANCE DATE (MMI)D/YYYY) 09/16/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Willis Insurance Services of CA Inc 3536 Concours, Suite 220 Ontario, CA 5594 License #0371719 719 NcAO.NTA:cT Dottie Adams AIC�Ne E„t 909476-3300 ac Nc: 909-084-5184 E-M IL AODREs , dorothy.adams@willis.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Philadelphia Indemnity Ins Co 118058 INSURED Olive Crest INSURER B: Philadelphia Indemnity Ins Co 23850 2130 E. 4th St., Ste. 200 Santa Ana, CA 92705 INSURERC: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONTRACTOR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VTR TYPEOFINSURANCE INSR S UBN WVD POLICYNUMBER MINDDYEFF MPIM1DDYEXP LIMITS A GENERAL LIABILITY PHPK766115 9/01/2011 0910112012 EACH $1,000,000 X: COMMERCIAL GENERAL LIABILITY ��OCCURRENCE PREMISES E,,oMEOrence $1,000,000 CLAIMS -MADE I OCCUR MED EXP (Any one pe on) s20 000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG s3,000,000 POLICY P QT LOC $ AUTOMOBILE LIABILITY PHPK766115 9/01/2011 09/01/201 McINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per awident) $ X MIRED AUTOS )( NON -OWNED AUTOS PROPERTY DAMAGE Per a " dent $ S B I UMBRELLA LIAR IX OCCUR PHUB357623 9/01/2011 09101/2012 EACH OCCURRENCE $10000000 AGGREGATE $10 000 000 X EXCESS LIAR CLAIMS -MADE DED I X RETENTION $10000 $ WORKERS COMPENSATION WC STATIJ I OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT S EL. DISEASE - EA EMPLOYEE'S (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below i E-L. DISEASE - POUCY UMIT $ A ABUSE PHPK766115 9/01/2011 09/01/201 $1,000,000 / $1,000,000 A PROFESSIONAL LIAB PHPK766115 9/01/2011 09/011201 $1,000,000 I $3,000,000 A EE DISHONESTY PHPK766115 9/01/2011 09/01/201 $500,000 / $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Grant Certificate Holder is Additonal Insured per'Additional Insured Endorsement for Commercial General Liability Policy' attached 10 Day Notice of Cancellation for Non Payment of Premium City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED B EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REP SENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S856106/M854076 APPROVED AS TO FORM P. LISP s.. STORCK Assistant City Attorney, 2DADA