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OP ID: AL
<br />Acr�_° ° CERTIFICATE OF LIABILITY INSURANCE
<br />DAT02117115 )
<br />02117115
<br />_
<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 requiro an endorsement. A statement on this cortiflcato does not confer rights to the
<br />cortiflcato holder In liou of such ondorsement 6 .
<br />PRODUCER 020.943 -2200
<br />CONTACT
<br />Angola Love
<br />Narver Insurance
<br />641 W. Las Tunas Drive 026. 299.1010
<br />PO 60%1609
<br />San Gabriel, CA 91776
<br />Robert Molinaro
<br />p "o "E
<br />--— ° °-' °' °°
<br />all 026. 943.2225 FAX Ner 626.2991010
<br />npo
<br />Gs• • alovo@narver.com
<br />3,
<br />PRODUCER
<br />CUSTOMER
<br />I :KIDWO.1
<br />EACH OCCURRENCE ,3
<br />INSUREHHu APPORDING COVERAGE
<br />NAIC4
<br />$ 100,000
<br />INSURED KidWorks Community Development
<br />INSURER A I Philadelphia lRemaraty lne.
<br />16056
<br />Corporation
<br />1902 West Chestnut Avenue
<br />INSURER E ; Evomst Nallonal Insurance
<br />10120
<br />01107110
<br />Santa Ana, CA 92703 -4304
<br />INSURER c
<br />INSURER O:
<br />INSURER a:
<br />3 TNy— 5,000
<br />INSURER
<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 DE 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 />ry
<br />ILTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />BOER
<br />POLICY NUMBER
<br />MMIDI DYE
<br />61N��(YW
<br />LIMIT?
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE ,3
<br />1,000,000
<br />p EM E "a uc•t " r
<br />$ 100,000
<br />A
<br />X COMMERCIAL GENERAL LIABILFY
<br />PHPK12841M
<br />01107/15
<br />01107110
<br />CLAIMS-MADE 1XI OCCUR
<br />MF_D EXP (Any one ep r4nn)T
<br />3 TNy— 5,000
<br />PERSONAL B ADV INJURY
<br />S 1,000,000
<br />GENERALAGGREGATE
<br />Is 3,000,000
<br />GENE AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS- COMPIOPAGG
<br />Ll 3,000,000
<br />X POLICY
<br />Q Z-?T F7 LOG
<br />$
<br />AS TOMOMLRUADILITY
<br />COMBINED SINGLE LIMIT
<br />•S 1,000,000
<br />X
<br />ANYAUTO
<br />F HPKI284134
<br />07/07115
<br />07107110
<br />(Ea eccldenp
<br />BODILY INJURY (Per person)
<br />ALLOWNEDAUTGS
<br />eODILV INJURY(Peraccldon0
<br />$
<br />JX
<br />SCHEDULED AUTCS
<br />PROPERTY DAMAGE
<br />•
<br />HIRE DAUTOS
<br />PIIPKI244134
<br />01/07115
<br />01/071/0
<br />(Per ameldent)
<br />$
<br />A
<br />NON- OWNEDAUrOa
<br />PHPK1284134
<br />01/07115
<br />01/07110
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X OCCUR
<br />EACH OCCURRENCE
<br />S 11000,00
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAR
<br />CLAIMS-MADE
<br />PHU0.0
<br />67501
<br />01107115
<br />01107116
<br />DEDUCTIBLE
<br />------- ... ................... ........ . —..
<br />$
<br />__
<br />$
<br />RETEN I N S 10,000
<br />.�.-
<br />...v,- ....W...
<br />IX WW 01191
<br />AND EMPLDYERS'LIAOILITY
<br />ANDEMRSCOMPELIAILIT YIN
<br />TOOSL10,11 i R .......... .e ... ..
<br />13
<br />ANY PROPRIETOR(PARTNEREXECUTIVE
<br />5900001267
<br />02101/15
<br />02/01116 :EL.EACHAOCiDBN7 $ 1,000,000
<br />OFPICERIMEMDER EXCLUDED?
<br />in Nip
<br />NIA
<br />EL DISEASE EA EM(Mandatory PLOYCP $ 1,000,000
<br />�aoCRIP�10 OFOPERATIONS mflw
<br />I E,L. DISEASE • POLICY LIMIT $ 1,000,000
<br />A
<br />Professional
<br />PtIPK12E4134
<br />01!07115
<br />01107fl6 !Per Clalm 1,000,000:
<br />Liability
<br />I Aggragate 3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Sahedula, If mare space Is required)
<br />Subject to all policy terms conditions and exclusions. 10 days notice of
<br />cancellation in the event o non- paymeat of premium.
<br />City of Santa Me named as additional insured as rospacta General Liability
<br />Form# CG 20 26 04 13 per written contract or agreement
<br />CERTIFICATE HOLDER CANCELLATION
<br />01086.200A t118 L11AAIJ 1UINUtrl9ervod.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of A
<br />Laura A, Rossini
<br />Senior A5SiSrnnI Citll Att .. �,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City f Santa Ana
<br />y
<br />THE EXPIRYfION DATE THEREOF,. NOTICE WILL BE DELIVERED IN
<br />ACCOROANCE WITH TI'IE POLICY PROVISIQNS,
<br />Attn: Risk Management
<br />20 Civic, Center Plaza
<br />Santa Ana, CA 92704
<br />AUTHORIZED AWREDDNTATIVE
<br />01086.200A t118 L11AAIJ 1UINUtrl9ervod.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of A
<br />Laura A, Rossini
<br />Senior A5SiSrnnI Citll Att .. �,
<br />
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