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Jun 131206:40p 0000000000 <br />K- - <br />MERCY-2 OP ID: 3C <br />CERTIFICATE OF LIABILITY INSURANCE 7106105/12 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON SHE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAC E AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IS iUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUE ROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this cert icate does not confer rights to the <br />certificate holder in lieu of such endorsement s). _ <br />PRODUCER 714-369-2998 NNNE: Stephanie Dufour <br />Dufour Insurance Services, LLC PHONE FAX <br />5611 Littler Drive 714-840-6357 ,? No Ell: 714-369-2998 __LAtc No): 714-840-6357 <br />Huntington Beach, CA 92649 E•wIA? <br />AoDrsESS: Stephanie@dufourinsura ice.com <br />Stephanie Dufour <br />INSURER(S) AFFORDING CC ?IERAGE NAIC s <br />INSURE R A : Travelers _Pro pert rLC asu l.lty <br />INSURED Mercy House Living Centers Inc INSURER a:Seabright Insurance Col ipany 15563 <br />P.O. Box 1905 <br />Santa Ana, CA 92702 WMARER c: Travelers IndemnigConlpany - <br />dSURER O: <br />IWURER F <br />COVERAGES CERTIFICATE NUMBER: REVIS ON NUMBER: <br />TH;S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM -D ABOVE FOR THE POLICY PFRn <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM !NT WITH RESPECT TO VA-IC-I -H1 . <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE N. IS SUBJECT TO ALL THE TERMS <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> <br />INSRTYPE OF INSURANCE <br />LTR <br />POLICY NUMBER M? YYY __ . -- <br />MMIDIDYf P LIMITS <br />1 GENERAL LIABILFTY EACH C -CURRENCE S 1,000,000 <br />A X GENERAL LIABILITY <br />COMMERCIAL X ' I6608B02700912 I 05f02f12 <br />- i - - - <br />05/02/13 I, DAMP.TO RENTED <br />PREMIX -S Ea oca. TPM I S 100.000 <br />l <br />CLAIMS-MADE FY7 OCCUR <br />__ NED Ex , <br />Arp ore person) i i. 10.000 <br /> PERSO' AL & ADV INJURY $ 1,000,000 <br /> GENER, .AGGREGATE E 2,000,000 <br />GEN'L AGGREGA-E LIMIT APPLIES PER: PRODU' TS-CO MPICR AGG 1 2,000.000 <br />X POLICY PRO LOC 'Ded.- $0 $ <br /> AUT OMOBILE LIABILITY EDMBtN --C111YGLE LI1611T $ 1,000.000 <br /> <br />A <br />ANY AUTO <br />X <br />BA884667512 <br />0$102112 -- - --- <br />05102!13 BODILY N.11PY Yer e.son; E <br />P <br /> <br />_ ALLO\MNED SCHEDULED <br />AUTOS AUTOS <br />? --- - <br />- <br />- - - <br />BODILY NJl1RV Per <br />aocltlenl) S <br /> X NON-OWNS <br />HIREDAJTOS <br />X AUTOS ? .-. <br />PROPEF'Y-UAMAGE -_-_ - I <br />iPer arcbnt?_ _ <br /> <br />s <br />Ded-$ i00/$1 000 <br /> X UMBRELLA LIAB X OCCUR i <br />1 I EACH0 CURRENCE S 4,000,000 <br />C EXCESS LIAB CLAINIS-MADE X 660BB02700912 05102J12 05002J13 accRE, ATE : s 4,000,00 <br /> DED X R <br />10000 <br /> =TENTION$ S <br /> WORKERS COMPENSATION -W( ?-U-CTH- <br />T <br />X <br />I <br /> AND EMPLOYERT LIABILITY Y!N I ij-QF Y LN <br />__ <br />TS ER <br />g ANY PROPRIETORIPARTNEWEXECUTFVE 881123517 02!08112 02108H3 E <br />EAC iACCIDrNS 1 <br />000 <br />00 <br />T <br /> OFFICER/ME MBER EXCLUDED, N I A I ._ <br />1 <br />, <br />--- _ - - <br />- _ - <br /> {MandatoryIn NH) E. L DIEt ASE EA EMPLOYEE $ 1 .000,000 <br /> 1' yes. describe under <br /> DESCRIPTION OF OPERATIONS oelow E.L. DfSF ASE -POLICY LIMIT S 1.000,00 <br />A Professional Liabi X 6608B027OD912 05102/12 1103 <br />0 Per Oc : 1,000,00 <br />A use Liability j X 608802700912 05/02!12 : <br />: <br />102/13 Aggrecate 1,gQQDOI <br />®. <br />DESCRIPTION OF 0PERATIONS f LOCATIONS f VEHICLES (Attach ACORD 101, AcIdiUorfal Remarks Schedule, It more space is required) <br />Re: CD$G, ESG, and HPRP grants. City of Santa Ana, its officers, employees, so NIB <br />agents, volunteers and representatives are named additional insureds with ?YgOm * K <br />respect to the operations of the named insured & this policy is primary per <br />the attached endorsement. Worker compensation coverage excluded, evidence S?Or'tG Oy <br />only. 10 days notice of cancellation for non-payment of preatium. PktOrr <br />CERTIFICATE: HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVI ;IONS. <br />Frank Hernandez <br />20 Civi <br />C <br />t <br />Pl <br />B <br />c <br />en <br />er <br />aza <br />ox 1986 <br />Santa Ana <br />CA 92702 AUTHORIZED REPRESENTATIVE <br />, y <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD