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MERCY-2 OP ID: SD <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />05/11/11 <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), AUTHORIZED <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 <br />Dufour Insurance Services, LLC 714-369-2998 <br />5611 Littler Drive 714-840-6357 <br />Huntington Beach, CA 92649 <br />Stephanie Dufour <br />CONTACT <br />NAME: Stephanie Dufour <br />ac° No Ext :714-369-2998 ac No : 714-840-6357 <br />E-MAIL h <br />ADDREss: Ste p anie dufourinsurance.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA:Philadelphia Insurance Compani <br />INSURED Mercy House Transitional <br />Living Centers <br />INSURER 8: Seabright Insurance Company <br />P.O. Box 1905 <br />INSURER C : <br />INSURER D : <br />Santa Ana, CA 92702 <br />INSURER E <br />INSURER F • <br />GUVtKAUt5 CFRTIFICATF NIIMRFR• DI71kIlclniu 10HM12CD• <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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IN <br />R <br />TYPE OF INSURANCE <br />NSR <br />POLICY NUMBER <br />POLICYEFF <br />MM/DDY� <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X Professional <br />X <br />PHPK714999 <br />PHPK714999 <br />05102/11 <br />05/02/11 <br />05/02/12 <br />05/02/12 <br />PREMISES Ea occurrence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />X <br />Abuse <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />A <br />PHPK714999 <br />05/02/11 <br />05/02/12 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />PRODUCTS -COMP/OPAGG <br />$ 2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />X <br />PHPK714999 <br />05102/11 <br />05/02/12 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED X SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />X <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Peraccident <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />X <br />PHUB343841 <br />05102/11 <br />05/02/12 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />AGGREGATE <br />$ 1,000,000 <br />DED X RETENTION $ 10000 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />BB1113517 <br />02/08/11 <br />02/08/12 <br />- <br />WC STATU- OTH- <br />X TORY LIMITS ER <br />_ <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E.L. DISEASE - POLICY LIMIT 1 <br />$ <br />A <br />Professional Llabi <br />X <br />PHPK714999 <br />05/02/11 <br />05/02/12 <br />Per Occ 1,000,000 <br />A <br />Abuse Liability <br />X <br />PHPK714999 <br />05/02/11 <br />05/02/12 <br />Aggregate 1,000,00 <br />®R <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Re: CDBG, ESG, HPRP City <br />and grants. 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 (— S�oRGK <br />only.10 days notice of cancellation for non-payment of premium. Attorney <br />�ssista ntC <br />/ ity <br />City of Santa Ana <br />Frank Hernandez <br />20 Civic Center Plaza Box 1988 <br />Santa Ana, CA 92702 <br />ACORD 25 (2010105) <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 />U 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />