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MERCY -2 OP ID: SD
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DA05 /111201 Yf
<br />a5r11r2a1s
<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 />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Dufour
<br />NAME CT Stephanie Dufour
<br />PHONE 714 -369 -2998 FAX 714 -840 -6357
<br />A1c No. Ex A1C, No
<br />A oRE S$: Stephanie @dufourinsurance.com
<br />Stephanie
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A : Great American Insurance Compa
<br />INSURED Mercy House Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />INSURER B: Great American Insurance Compa
<br />A
<br />INSURER C: Travelers Propert Casualty
<br />X
<br />INSURER D :Great American Insurance Group
<br />PAC426 -08 -82
<br />05102/2016
<br />INSURER E:
<br />PREMISES Ea occur ence
<br />$ 100,00
<br />INSURER F :
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />20 Civic Center Plaza Box 1988
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [XI OCCUR
<br />X
<br />PAC426 -08 -82
<br />05102/2016
<br />0510212017
<br />PREMISES Ea occur ence
<br />$ 100,00
<br />MED EXP (Any ore person)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Prof. Liability
<br />PAC426 -08 -82
<br />0510212016
<br />05/0212017
<br />X
<br />Sex Abuse /Miscond
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />A
<br />PAC426 -08 -82
<br />0510212016
<br />05/0212017
<br />GEN'LAGGREGATE LIMIT APPLIES PER!
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,00
<br />X POLICY PRO LOG
<br />Ded.- $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1 000
<br />$ , ,00
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />X
<br />PAC426 -08 -82
<br />05102/2016
<br />03102/2017
<br />X
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Peraccidenl)
<br />$
<br />PROPERTY DAMAGE
<br />PERACCIDENT
<br />$ AC
<br />Ded- $500
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,00
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />UMB 4260883
<br />05102/2016
<br />05102/2017
<br />AGGREGATE
<br />$ 4,000,00
<br />DEO X RETENTION 10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETCRIPARTNEPJEXECUTIVE F—]
<br />OFFICER/MEMBER EXCLUDED?
<br />{Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTIONOFOPERATIONSbelow
<br />N/A
<br />UB4216T17716
<br />02/0812016
<br />02/0812017
<br />X WC STATU- OTH-
<br />TORY LIMITS E
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - FA EMPLOYEE
<br />$ 1,000,00
<br />F,L.DISEASE - POLICY LIMIT
<br />$ 1,000,00
<br />D
<br />Cyber Liability
<br />X
<br />NLP3642944
<br />01/29/2016
<br />01/29/2017
<br />Per Occ 1,000,00
<br />X
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS ! LOCATIONS 1 VEHICLES (Attach ACORD 101, Addltlonal 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 excluded, evidence
<br />only. 10 days notice of cancellation for non-- payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name 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 />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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