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11tvV mpp <br />WUMI:N -3 OP It)' I <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMDDrYYYY) <br />COMMERCIAL GENERAL LIABILITY <br />CLAWS-MACE T OCCUR <br />09/08/2014 <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 />Fullerton Insurance Service <br />CDI #0696796 <br />P.O.B°X4064 <br />Fullerton CA 92834.4064 <br />Leslie A. McCarthy, CIO <br />NAW A T Leslie A. McCarthy, CIC <br />PHC NNO Ex1:714- 577.5800 A+c No: 714- 447 -0011 <br />EMAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Nonprofits Ins. Alliance of CA <br />$ 6,00 <br />INSURED Women's Transitional Living <br />Mrs. Gig! Tsontos <br />P.O. Box 6103 <br />INSURER B: New York Marine & General Ins. <br />16608 <br />INSURER C <br />GENERAL AGGREGATE <br />INSURER D: <br />PRODUCTS - COMP /OP AGG <br />Orange, CA 92863 <br />INSURER E: <br />$ Included <br />A <br />AU <br />X <br />_ <br />X <br />X <br />INSURER F <br />X <br />\,- YIJIVIY ItlUlY16C.Ri <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 ­SR ADDL 9M LT TYPE OF INSURANCE POLICYNUMBER WMI��Y� MM/DCIYEXP LIMITS <br />A <br />X <br />GENT <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAWS-MACE T OCCUR <br />X <br />201401835NPO <br />09/01/2014 <br />09/01/2015 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />ppEMlsES Ee owurrence <br />$ 100,00 <br />MED EXP (Any one person) <br />$ 6,00 <br />PERSONAL &ADV INJURY <br />$ 11000100 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ P JECT LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />PRODUCTS - COMP /OP AGG <br />$ 1,000,00 <br />Emplo Ban <br />$ Included <br />A <br />AU <br />X <br />_ <br />X <br />X <br />UNCOILS LIABILITY <br />ANY AUTO <br />ALL OWNED $CHEOULED <br />AUTOS AUTOS <br />HIRED AUTOa X AUTOaWNED <br />$500 Comp X $1000 Coll <br />X <br />207401835NP0 <br />09/01/2014 <br />09/01/2015 <br />COMBINED SINGLE LIMI F <br />Ea ae�lnert ,,,. <br />$ 1,000,00 <br />BODILY INJURY (Per person) <br />-- ---- <br />_.......... <br />$ <br />-.. - -- <br />BODILY INJURY (Per accident) <br />- <br />-DAMAGE <br />$ <br />PROPERT <br />Porecemerrt <br />$ <br />A <br />B <br />X <br />UMDRELLA LIAU <br />EXCESS UAa <br />X <br />OCCUR <br />CLAIMS -MADE <br />N!A <br />201401835UMENPO <br />WC20140006441 <br />09/01/2014 <br />03/28/2014 <br />0910112016 <br />03!28/2015 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />AGGREGATE <br />$ 11000100 <br />DED X RETENTIDN$ None <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER /EXECLITIVE YIN � � <br />OFFICER /MEMBER EXCLUDED? T <br />Prod /Com , <br />_ <br />X SEAT TE �R H <br />$� 1,000,00 <br />- - - --- <br />E. L. EACH ACCIDENT <br />$^ 11000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Adelllonal Remarks Schedule, maybe atechetl it more space Is required)) <br />City of Santa Ana, its officers, agents employees and volunteers are named"�„Ti P <br />as additional insured as respects to their interest in connection with the <br />named insured. Addit'l insured as respects to general liability per form <br />attached to pol. This pol is primary & is not additional to or contributing 10 ey <br />w/ any other insurance *except for gross negligence and willful misconduct. P E•S �ttOCCI <br />x,15 G�ty <br />P5sls�art I' „I <br />CISANBE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana -ESG M -26 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS. <br />Daniel Perez AUTHORIZED REPRESENTAT�IIV�EE�-�� pp � <br />P.O. BOX 1908 927 (,— 1 �•.L_.i-�t�X-.d <br />Santa Ana, CA 92702 1. ,,�,1 <br />O 1988.2094 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/09) The ACORD name and logo are registered marks of ACORD <br />