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MERCY -2 OP Ila: SD
<br />®: CERTIFICATE O1 LIABILITY INSURANCE
<br />RA03107/2017Y?
<br />n�1a712o17
<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 SY 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(fes) 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 />6619 Littler Drive
<br />too _ T Stephanie Dufour
<br />PHONE t , 714-369-2998 plc No ; 794-840-6857
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />MAIL
<br />ADDREss.. Stophanio@dufouriiisurance.com
<br />INSURERS AFFORDING COVERAGE NAIL #
<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 8; Great American Insurance Compa
<br />INSURER C: NOVA Casualty Company
<br />INSURER D: Great American Insurance Group
<br />INSURER E:
<br />INSURER ;
<br />05102!2016
<br />COVERAGE$ 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 DR 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 />IL R
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFF
<br />! i
<br />POLICY EXP
<br />MIDDIYYYY
<br />LIMITED
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX1 OCCUR
<br />X
<br />PAC426-0$ 82
<br />05102!2016
<br />05!0212017
<br />pREMMI9FS Esioocunno
<br />$ 100,000
<br />MED EXP (Any one psrson)
<br />$ 10,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />A
<br />X Prof. Liability
<br />PAC426-08-$2
<br />05/02/2016
<br />05/02/2017
<br />GENSRALAGCREGATE
<br />$ 2,000,000
<br />A
<br />X Sex Abuse/Miscond
<br />PAC426-08.82
<br />05/02/2016
<br />05/02/2017
<br />GEN'LAGGREGATELIMITAPPLIESPER:
<br />PRODUCTS -COMPIOPAUG
<br />$ 2,000,000
<br />X POLICY PRD" Loc
<br />I
<br />Ded.- $0
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINER SING E LIMIT
<br />Ee acoident
<br />11000,000
<br />BODILY INJURY (Per person)
<br />If
<br />A
<br />ANY AUTO
<br />X
<br />PAC426-08-$2
<br />0510212010
<br />05/02/2017
<br />X
<br />ALL OWNED SCHEDULED
<br />UT0XA0
<br />FIIRED AUTOSX NON -OWNED
<br />AUT08I
<br />BODlYINJURY (Per accldent)
<br />$
<br />PROPERTYDAMAGE
<br />PER ACCIDENT
<br />$ AC
<br />Ded- $500
<br />�
<br />X
<br />UM13RELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />X
<br />LIMB 42$0883
<br />05/02/2016
<br />05/02/2017
<br />DED I X I RETENTION 10000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRCPRIETORlPARTNERIEXECUTIVE— j
<br />OFFICERIMLMD? ER EXCLUDE
<br />(MandatorylnNH)
<br />Res descof a under
<br />S6RIPTION OF OPERATIONS BOlpw
<br />NIA
<br />CF1-WK-10000043-00
<br />02/08/2017
<br />02108/2018
<br />STATU- l' DI'H-
<br />X IN
<br />F, L, EACH ACCIDENT
<br />$ 1,000,000
<br />E,LDISEASE- EAEMPLOYEE
<br />---
<br />$ 1,000,000
<br />RL, DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Cyber Liability
<br />XNLl'3642944
<br />01/2912017
<br />01129/2018
<br />Per Oce 1,000,000
<br />X
<br />Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 941, Addltlonnl Remarks Schedule, If more space is regUlred)
<br />Re: CDHG, ESC, 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 y
<br />only. 10 days notice of cancellation for non-payment of premium. e
<br />City of Santa Ana
<br />Frank Hernandez
<br />20 Civic Center Plaza Box 1988
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE=LLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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