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`'� O® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE I
<br />6/10/2015�)
<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 pollcy(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 />McNamara Insurance Services, Inc.
<br />1010 B Street, Suite 317
<br />San Rafael CA 94901-2920
<br />CONTACT Michael McNamara
<br />NAME:
<br />PHONE (415)457-7856 FAX
<br />NIT, 1415)457-7698
<br />nooaless:Mike@4apolicy.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A:Philadel hia Insurance
<br />18058
<br />INSURED
<br />Tim Bowen, DBA: Play -Well TEKnologies
<br />224 Greenfield Ave. Ste B
<br />San Anselmo CA 94960
<br />INSURERB Rated by Multi Hartford Cols.
<br />37478
<br />INSURERC:
<br />INSURER D:
<br />INSURER E :
<br />1 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:CL1522401769 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AD
<br />BR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDEIYVYV
<br />POLICY EXPM
<br />MMIDDNYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />RRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADEOCCUR
<br />X
<br />PHPKI297595
<br />3/5/2015
<br />10/1/2016
<br />RENTED
<br />Be occurre ce
<br />100,000
<br />$A
<br />y one person)
<br />$ 5,000
<br />ADV INJURY
<br />$ 1,000,000
<br />GGREGATE
<br />$ 2,000,000
<br />GENE AGGREGATE LI MIT APPLIESPER:
<br />-COMPIOP AGO
<br />$ 2,000,000
<br />\
<br />X POLICY PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />BODILY INJURY (Pan person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />#A'
<br />y4..
<br />yg��
<br />'aJ
<br />BODILY INJURY(Peraccident)
<br />$
<br />PROPERTY DAMAGE
<br />Peraccidenl
<br />$
<br />$
<br />X
<br />UMBRELLAUAB
<br />X
<br />OCCUR
<br />r4y
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />V
<br />DED I X I RETENTION$ 10, DOC
<br />$
<br />FRUB490577
<br />3/5/2015
<br />10/1/2016
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />X WC STATU- OTH-
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />57wECTQ7835
<br />3/5/2015
<br />3/5/2016
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />f yyes, describe under
<br />DESCRIPTIONOFOPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT
<br />$ 11000,000
<br />A
<br />Professional Liability
<br />EPK1297595
<br />/5/2015
<br />10/1/2016
<br />EACH INCIDENT 1,000,000
<br />A
<br />Abuse/ Molestation
<br />EPK1297595
<br />3/5/2015
<br />10/1/2016
<br />AGGREGATE 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the General
<br />Liability Deluxe Endorsement: Human Services PI-GLD-HS attached to this policy. Coverage is primary
<br />&non-contributory per the Additional Insured Primary and Non -Contributory Insurance PI-MANU-1
<br />CERTIFICATE HOLDER CANCELLATION
<br />cacosta@santa-ana.org
<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 />City Of Santa Ana
<br />Attn: Carmen Acosta
<br />AUTHORIZED REPRESENTATIVE,
<br />ATTN PRCSA
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />Kent Schaum/KENSCH ,,�.�!�-------___.
<br />ACORD 25 (2010105)
<br />INS025 ommms n1
<br />@ 1988.2010 ACORD CORPORATION. All rights reserved.
<br />Th. ACr1Rn namE Ertel Innn ErE rmnieferorl mar4e of ARf)pn
<br />
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