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OP ID: AL
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DAT 07124/115 5 V)
<br />07/24
<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 626. 943 -2200
<br />CONTACT Renee Morales
<br />641 W. Insurance 626 - 299 -1010
<br />641 W. Las Tunas Drive
<br />PO Box 1509
<br />San Gabriel, CA 91778.1509
<br />Robert Molinaro
<br />PHONE 626. 943.2225 FAX. 626 - 299 -1010
<br />AIC rvo Ext : AIC No
<br />EMAIL l
<br />ADDRESS: rmorales@narver.com
<br />PRODUCER ,KIDWO -1
<br />CUSTOMER ID .
<br />INSURER(S) AFFORDING COVERAGE
<br />NAICW
<br />INSURED Kid Works Community Development
<br />INSURER A: Philadelphia Indemnity Ins.
<br />18058
<br />Corporation
<br />1902 West Chestnut Avenue
<br />INSURER B: Everest National Insurance
<br />10120
<br />PHPKI284134
<br />Santa Ana, CA 92703.4304
<br />INSURER C:
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />INSURER D :
<br />$ 1,000,000
<br />INSURER E:
<br />INSURER F:
<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 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 />ILTR
<br />TYPE OF INSURANCE
<br />IN SR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYY( )
<br />POLICY EXP
<br />(MMIODIVYYY
<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 />PHPKI284134
<br />01/07115
<br />01/07/16
<br />PREMISES (Ea occurrence)
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG
<br />$ 3,000,000
<br />X POLICY P". LOG
<br />$
<br />X
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />PHPK1284134
<br />01/07115
<br />01/07/16
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />A
<br />X
<br />SCHEDULEDAUTOS
<br />HIRED AUTOS
<br />PHPKI284134
<br />01/07/15
<br />01/07116
<br />PROPERTY DAMAGE
<br />(Per moldent)
<br />$
<br />•
<br />X
<br />NONAWNEDAUTOS
<br />PHPK1284134
<br />01/07/15
<br />01/07116
<br />$
<br />X
<br />UMBRELLA LIAS
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />•
<br />EXCESS LIAS
<br />-
<br />CLAIMS -MADE
<br />PHUB487501
<br />01/07115
<br />01/07/16
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $ 10,000
<br />B
<br />WORKERS COMPENSATION
<br />WORKERLOVERSLIATION
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />5900001207
<br />02/01/15
<br />02101116
<br />X WCSTATU- OTH-
<br />TORYLIMIT ER
<br />E. L, EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />If yes,descrip. under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Professional
<br />PHPK1284134
<br />01/07/15
<br />01/07/16
<br />Per Claim 1,000,000
<br />Liability
<br />I
<br />I
<br />Aggregate 3,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requl rod)
<br />City of Santa Ana, its officers, agents, representatives, employees and
<br />volunteers are named as Additional Insureds as respects General Liability,
<br />per written contract or agreement. f
<br />Subject to all policy terms, conditions and exclusions. 30 days notice of
<br />cancellation. 10 days notice in the event of non - payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION _ v
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />i:lt of Santa Ana Community
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Y y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Development Agency (M -25)
<br />20 Civic Center Plaza
<br />Po Box 1988
<br />Santa Ana, CA 92702.1988
<br />AUTHORIZED REPRESENTATIVE
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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