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<br />MERCY -2 OP ID: SO
<br />A� v, CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 05 /01 /2014Y)
<br />o5 /9vzola
<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(les) 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
<br />5611 Littler Drive
<br />Huntington Beach, CA 92849
<br />Stephanie Dufour
<br />CONTACT
<br />NAME; Stephanie Dufour
<br />PHO
<br />_
<br />ONE, FpC No; 714- 840.6357
<br />-Mao
<br />ADORE
<br />SS: Stephanie@dufourinsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />INSURER A! Travelers Indemnity Company
<br />002517
<br />$ 1,090,90
<br />INSURED Mercy House Living Canters Inc
<br />P.Q. Box 1905
<br />Santa Ana, CA 82702
<br />INSURER a; Travelers Pro rt Casualt
<br />X
<br />INSURER C:Travelers Indemnity Company
<br />002517
<br />INSURER D:
<br />05/0212015
<br />PREMISES ER ccurrence
<br />INSURER E:
<br />MED EXP(My one person)
<br />$ 10,000
<br />INSURER F:
<br />$ 1,000,00
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />INS
<br />rypE OF INSURANCE
<br />D L
<br />win
<br />POLICY NUMBER
<br />POLICV EFF
<br />M D
<br />P LI YEXP
<br />I IWYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,090,90
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />X
<br />6608BO2700914
<br />05)02/2014
<br />05/0212015
<br />PREMISES ER ccurrence
<br />$ 100,00
<br />MED EXP(My one person)
<br />$ 10,000
<br />PERSONAL B ADVDLU RY
<br />$ 1,000,00
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - CCMPIDP AGG
<br />$ 2,000,00
<br />X POLICY
<br />!I LOC
<br />Ded: $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED$ GLE LIMIT
<br />Ea accident
<br />1,000,00
<br />A
<br />ANY AUTO
<br />X
<br />BABS04667514
<br />0510212014
<br />0510212015
<br />BODILY INJURY (Per Pam.)
<br />$
<br />X
<br />ALL AUTOWNED X AUTOSULED
<br />HIREDAUTOS X AUT09WNED
<br />BODILY INJURY (Per accident)
<br />$
<br />PRROPERTID °Ni AGE
<br />$ 50,090
<br />Ded. $5001$1000
<br />$
<br />X
<br />UMBRELLA LIAe
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,00
<br />O
<br />EXCESSLIAB
<br />I CLAIMS.MAOE
<br />X
<br />CUP3909T12014
<br />05/02/2014
<br />05/02/2015
<br />AGGREGATE
<br />$ 4,000,00
<br />BED I X I RETENTION $ 10000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETONPARTNEWEXECUTIVE
<br />OFFICERIMEMBEREXCLUDEDf
<br />(Mandatary In NH)
<br />If es.@
<br />D CRIP dascr ION e Under OF OPERATIONS below
<br />NIA
<br />1.184216T17714
<br />02108/2014
<br />02/08/2015
<br />WC STATU. TH6
<br />X ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E, L. DISEASE FA EMPLOYE
<br />$ 11000,09
<br />EL .DISEASE - POLICY LIMIT
<br />$ 11000.,00
<br />A
<br />Professional Llabl
<br />X
<br />66OBB02700914
<br />05/02/2014
<br />06/0212015
<br />Per Oce 1,000,00
<br />A
<br />Abuse Liability
<br />X
<br />66OBB02700914
<br />05/02/2014
<br />0610212015
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adach ACORD 101, Additional Remams Schedule, If mare space IS required)
<br />Re: COBB, ESG, and HPRP grants. City of Santa Ana, its officers, employees,
<br />agents, volunteers and representatives are named additional insureds with n
<br />r
<br />respect to the operations of the named insured & this policy is primary pergv 7��
<br />the attached endorsement. Woxkes compensation coverage excluded, evidence ji,i,� ii++
<br />only. 10 days notice of cancellation for non - payment of premium.
<br />-0cLISA
<br />E. 5TO�CK
<br />It AliorneI
<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 />©1988.2010 ACORD CORPORATION. All plants
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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