COMMUNITY SENIORSERV, INC (2). - 2013

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acc,RVP CERTIFICATE OF LIABILITY INSURANCE MATE 601201DD /VVYV) 0612812013 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(ies) 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 Marsh Risk & Insurance Services 17901 Von Kalman Avenue,Suite 1100 1949) 399 5800 License #0437153 CONTACT NAME: PH(A ONE /C No Ezt) FA AIX No: E -MAIL ADDRESS: INSURER(SJ AFFORDING COVERAGE NAIC # Irvine, CA 92614 INSURER A: Philadelphia Indemnity Insurance Company 18058 093650 CSS- GAWX -13 -14 INSURED Community SeniorSery INSURER B: Zenith Insurance Company 13269 INSURER C 1200 N. Knollwood Circle Anaheim, CA 92801 INSURER D: INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence INSURER F: MED EXP(Anyone person) $ 51009 COVERAGES CERTIFICATE NUMBER: LOS -001512616 -03 REVISION NUMBER- 1 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 CONTRACT OR 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. INBR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM/UD/YYYV POLICY EXP MMI 'IVYYY LIMITS A GENERAL LIABILITY PHPKI042632 0710112013 0710112014 EACH OCCURRENCE $ 1,0D0,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 21 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Anyone person) $ 51009 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP ASS $ 3,000,000 X PGLICV PRO- LOD JECT Sexual Misconduct $ toao,000 A AUTOMOBILE LIABILITY PHPKI042632 0710112013. - 0710112014 COMBINED SINGLE LIMIT Baaccident 1,000,000 X BODILY INJURY (Per person) _ $ ANY AUTO DED: Comp $500 - Collision $1,000 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) ( ) $ HIRED AUTOS NON -OWNED AUTOS _ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ AGGREGATE $ EXCESS LIAB C LAIMS -MADE DED I I RETENTION $ B WORKERS COMPENSATION Z070773204 07/0112013 0710112014 X wO STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A Al A _ E. L. EACH ACCT DENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 I $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, Its Officers, Officials, Employees, Agents & Volunteers are named additional insured with respoectto the operations of the named Insured per the attached CG 2gy6rq�( fsement, Such Insurance is primary and non - contributory perthe LlS^ �c tiva ti rn °� lb �.n r rnVA r M nvIUur=n UAIII CLLA I IUN F of Santa Ana M 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Box 1988 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN a Ana, CA 92702 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services John Graef © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD