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AC"R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMfD01YYYY)
<br />d3rd1f2d17
<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(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 />certificate holder In lieu of such endorsement(s),
<br />PRODUCER.
<br />CONTACT
<br />NAME:. ...__.... .._..........,_.._.,.
<br />Marsh Risk & Insurance Services
<br />PHONE .. '.— �.... FAX
<br />17901 Von Karman Avenue, Suite 1100
<br />(949) 399'-SB00; License 40437153
<br />E-MAIL
<br />ADDRESS:, ..-.._�..._......,._...m.. „ _ ..._....-_.
<br />_
<br />INsURERIYS)AFFORDINGCOVERAGE NAIL#
<br />Wine, CA 92614
<br />Alin! NewpodBeach,CenRequest@marsh.com/F: 212-9484323
<br />INSURER A: Philadelphia Indemnity Insurance Company 18058
<br />093650-CSS-GAWX•16.17
<br />INSURED
<br />INSURER B: Zenith insurance Company..._.. 13269
<br />Community SeniorSery
<br />—
<br />1200 N Knodwood Circle
<br />rNSI�RER c_;
<br />Anaheim, CA 92801
<br />INSURER D
<br />INSURER E : ..__..................... '.
<br />MED EXP (Any one person) Y S ... 5,000
<br />INSURER F
<br />�.cc. f"=TICIF`ATC Milli I OSA 911 i'H444H-12 HFVISICIN IVLII B1l _K: 10
<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 �ADDL�SUI1R. � -...POLICY ERF....' POLICY EXP LIMITS'.
<br />LTR. TYPE OF INSURANCE POLICY NUMBER M/DDTYYYY MMIDDIYYYY
<br />A ''.�
<br />X COMMERCIAL GENERAL LIABILITY
<br />..PHPK1516506
<br />',Q7Pd112016
<br />0710112017
<br />EACH OCCURRENCE $ 1,000,000
<br />_
<br />DAMAGE TO RENTED �
<br />00,000
<br />CLAIMS -MADE L�.J OCCUR.
<br />PREMISES (Ea ourrgq;a)__ $ _1
<br />oc
<br />MED EXP (Any one person) Y S ... 5,000
<br />PERSONAL &.ADV INJURY $ 1,000,600
<br />GENERAL AGGREGATE $ 3,000,000
<br />.___m........
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY JERCOT E LCC
<br />PRODUCTS-COMPICPAGO S 3,00{i,000
<br />Sexual Misconduct
<br />$ 1,000,000
<br />OTHER_
<br />A
<br />AUTOMOB§LE LIABILITY
<br />PHPK'1516506
<br />0710112016
<br />0710112017
<br />COMFINED SINGLE LIMIT
<br />a accidentl._,_ ..
<br />$000 000
<br />. _
<br />X
<br />DED: Comp $500 - Collision $1,400
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />SOOILY INJURY (Per accident)
<br />I $
<br />AUTOS AUTOS
<br />NOWOWNED
<br />PROPERTY DAMAGE _
<br />$ .......
<br />._.__.. HIRED AU'rO3� .. .. AUT�gS
<br />Per a c d®�_.
<br />I
<br />$
<br />I UMBRELLA LIAR
<br />CCCUR.
<br />i
<br />EACH OCCUfiRENCE ....�_
<br />v,_ m
<br />$ .._.....,.
<br />EXCESS LIAR
<br />i, CLAIMS.MADe
<br />'� AGGREGATE
<br />DED S
<br />$
<br />B
<br />ENSATIDN
<br />WORKERS COMPENSATION
<br />2070773207
<br />0710112016
<br />071d1a'2417 X UTA7UTE
<br />AND EMPLOYERS' LIABILITY Y
<br />..-.,
<br />$ 1,000,D00
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE M
<br />N 1 A
<br />E,L, EACH ACCIDENT
<br />__..
<br />O,OdO
<br />$ 1,0O 0,
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />°, E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,009
<br />If Nyes describe under
<br />DESCRIPTION OF OPERA ioNS taelow
<br />I E.L-. DISFASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD AUI, Additional Remarks Schedule, may bye s required)
<br />The City of Santa Ana, its }fOCBrs, employees, agenic, volunteers, and representatives are included as additadsg(p al ers' rc n) where required by written contract, This Insurance is
<br />prmary and nun -contributory over any existing insurance and limited to liability arising out of the op of the $�9lh�s*urej i quiredAiaAitten contract,
<br />-ru
<br />City of Santa Ana.
<br />20 Civic Center Plaza M-23
<br />Santa Ana, CA 92701
<br />L.A
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERER IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance. Services
<br />Jahn Graef---
<br />IC1 l`JISr9-LUIS A4L7KLJ 4s LJIKYIJI'CAIIflAN. All 1191ILto lW*trlwau,
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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