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MERCY -2 OF ID: SD
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OA 0 r(m9/20 YYY)
<br />5(19/2015
<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 />certifloate holder In lieu of such ondorsement s .
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Beach.
<br />CO T A T Stephanie Dufour
<br />NANR
<br />P " ° "E Ext.714- 369.2998 qIc Nn: 714.840.6357
<br />al oRess: stephanio @dufourinsurence.com
<br />INSURER($) AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Groat American Insurance Compa
<br />INSURED Mercyy ox House Living Centers Inc
<br />P.O. B 1905
<br />Santa Ana, CA 92702
<br />INSURER B: Great American Insurance Com a
<br />INSURER Property
<br />P y Casualt
<br />INSURER D
<br />EACH OCCURRENCE
<br />INSURER E ;
<br />fd
<br />INSURER F;
<br />X
<br />lH�Y14 :7G[c]N."�NN:4ily10YA140111i F1z!t •. „e -
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIFS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />NSR
<br />LTR
<br />rypE OF INSURANCE
<br />II
<br />20 Civic Center Plaza Box 1988
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />M DD YYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />X
<br />PAG426.08.82
<br />0510212015
<br />0510212016
<br />pREMISE5 E occurrence
<br />$ 100,000
<br />MEO @ %P (Any one paYSbn
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS- COMP/OP AGO
<br />$ 2,000,000
<br />T POLICY
<br />PRO- LOG
<br />Bad.- $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE L I
<br />-me dccltlent
<br />1,000 ,000
<br />A
<br />ANY AUTO
<br />X
<br />PAC426 -08 -$2
<br />05/02/2015
<br />05102/2016
<br />BODILY INJURY (Per pereon)
<br />$
<br />_
<br />X
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AVTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY Per accldenl
<br />( )
<br />$
<br />PROP A 1A E
<br />PF.R CCIDENT
<br />$ AC
<br />DOCI $500
<br />$
<br />X
<br />UMBRELLA LIAB
<br />I X
<br />I OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />g
<br />EXCESS LraB
<br />CLAIMS -MADE
<br />X
<br />UMB 4260883
<br />05/02/2015
<br />05/02/2016
<br />DED I X I RETENTIONS 10000
<br />1
<br />IS
<br />C
<br />AN WORKERS
<br />D EMPI l.A
<br />.OVERSkB11LITY YIN
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />OFFICELLMEMSER EXCLUDED?
<br />(Mandatory in NH)
<br />IF qqes, describe under
<br />pESCRIP'rION OF OPERATIONS below
<br />NIA
<br />UB4216TI7716
<br />02108/2015
<br />02/08/2016
<br />X TORY WT OCR-
<br />E.L. EACH ACCIDENT
<br />�-
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional Llabi
<br />X
<br />PAC426.08.82
<br />05/0212015
<br />05/0212016
<br />Per Doc 1,000,000
<br />A
<br />Abuse Liability
<br />X
<br />PAC42 &08.82
<br />05/0212015
<br />05/02/2016
<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 />Re: CDSG, ESG, and HPRP grants, City of Santa Ana, its officers, employees, /
<br />agents, volunteers and representatives are named additional insureds with
<br />respect to the operations of the named insured & this policy is primary per `
<br />the attached endorsement. Workes compensation coverage exaluded, evidence
<br />n
<br />only. 10 days notice of oacellation for non-payment of premium.
<br />`,
<br />..�
<br />CERTIFICATE HOLDER CANCELLATION
<br />@'1088-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010105) The ACORD nama and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Frank Hernandez
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />@'1088-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010105) The ACORD nama and logo are registered marks of ACORD
<br />
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