|
A� O® CERTIFICATE OF LIABILITY INSURANCE
<br />D07113/2016 YY)
<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 />March Risk & Insurance Services
<br />17901 Von Korman Avenue, Suite 1100
<br />(949) 399 -5000; License #0437153
<br />Irvine, CA 92614
<br />CONTACT
<br />NAME:
<br />PHONE FAX No),
<br />ADDRIESS:
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Attn: Newperdleach Con Request @marsh com /F: 212 -946 -4323
<br />INSURERS AFFORDING COVERAGE
<br />NAIC H
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />18058
<br />093650- CSS- GAWX.15 -16
<br />INSURED
<br />Community SeniorSery
<br />INSURER B : Zenith Insurance Company
<br />13269
<br />1200 N, Knollwood Circle
<br />INSURER C:
<br />INSURER D
<br />DAMAGES(RENTED
<br />PREMISES RENT occurrence)
<br />Anaheim, CA 92801
<br />INSURER E
<br />MED EXP (Any one person)
<br />$ 5,000
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: LOS- 001794448 -09 REVISION NUMBER:9
<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 />R
<br />TYPE OF INSURANCE
<br />AOOL
<br />SUBR
<br />POLICVNUMBER
<br />MM /DOmYY
<br />MMl000 YV
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />PHPK1360737
<br />07101/2015
<br />07/01/2016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGES(RENTED
<br />PREMISES RENT occurrence)
<br />$ 100,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />X
<br />PRO-
<br />POLICY PRO- D LOC
<br />JECT
<br />PRODUCTS - COMP /OP AGG
<br />$ 3,000,000
<br />Sexual Misconduct
<br />$ 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK1360737
<br />07/0112015
<br />07/01/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJ CRY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />DED: Comp $500- Col lision$ 1,000
<br />1
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />UMBRELLA LIAR
<br />H
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED 7 1 RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE Y�
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />2070773206
<br />07/01/2015
<br />07/01/2016
<br />X I STATUTE OTH
<br />ER
<br />E. L EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers, and representatives are Included as additional insureds (except Workers Compensation)
<br />where required by written contract. This insurance is primary and non - contributory over any existing insurance and limited to liability arising out of the operations of the named Insured and where required by written
<br />contract.
<br />c-y-���
<br />tl`CiV L
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />John Graef
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|