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ACTOR" CERTIFICATE OF LIABILITY INSURANCE
<br />Doi/24/2017 DI��I
<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 />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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Marsh Risk & Insurance Services
<br />PHONEFAX
<br />17991 Ven Karmen Avenue, Suite 1100
<br />_IAID No Eau IAIG Nop
<br />(949) 399-5800; License #0437153
<br />E-MAIL
<br />ADDRESS:
<br />Irvine, CA 92614
<br />EACHOCCURRENCE $ 1,000,000
<br />Attn: NewpohBeach.CenRequest@mamh com/F: 212-948-4323
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Philadelphia Indemnity Insurance Company
<br />18050
<br />093650-CSS-GAWX-17-10
<br />INSURED Community Senior$ery
<br />INSURER B: Insurance Company Of The West
<br />27847
<br />INSURERC:
<br />-----
<br />1200 N, Knollwood Clfcle
<br />Anaheim, CA 92601
<br />INSURERD:
<br />INSURERE:
<br />INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: LOS -002226488-15 REVISION NUMBER: 17
<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 />ADOLSUBR
<br />INSID
<br />Me
<br />POLICYNUMBER
<br />POLICY EFF
<br />dMMIDDFYYYy1
<br />POLICY EXP
<br />(MMIDD1YYyYILIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Pamela Petersen.,
<br />PHPK1677957
<br />07/01/2017
<br />07/01/2016
<br />EACHOCCURRENCE $ 1,000,000
<br />CLAIMS -MADE C� OCCUR
<br />1_R1M`SESY.`.=.1..J $ 100,000
<br />MED EXP (Any one person) a 5,000
<br />PERSONAL&ADV INJURY 5 1,000,000
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE 5 3,000,000
<br />DELL
<br />X
<br />POLICY [:] PRO- ❑
<br />JECT LOC
<br />PRODUCTS -COMP/OP AGG $ 3,000,000
<br />OTHER'
<br />Sexual Misconduct $ 1,000,000
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPKI677957
<br />07/01/2017
<br />07/01/2018
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accident
<br />X
<br />ANY AUTO
<br />DED', Comp $500- Collision $1,000
<br />BODILY INJURY(Per person) $
<br />OWNED ASCHEDULED
<br />AUTOS ONLY UTOS
<br />BODILY INJURY Per accident $
<br />PROPERTY DAMAGE $
<br />_(Per scabbard) _
<br />HIRED Fl NON -OWNED
<br />AUTOS ONLY AUU70S ONLY
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />DED RETENTION$I
<br />1 $
<br />1
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITV YIN
<br />OFFICE IMEMB REXC EXCLUDED?
<br />(MandaR/MEM BER EXCLUDEW
<br />NH)
<br />NIA
<br />WVE503715200
<br />07/01/2017
<br />07/01/2018
<br />1 X PER oTH-
<br />STATUTE 1 ER
<br />_
<br />Ems. EACH ACCIDENT �$ 1,000,000
<br />EL.DISEASE - EA EMPLOVEEi$ 1,000,000
<br />Ues,dtoryin
<br />Dyes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />ELL DISEASE -POLICY LIMIT 1 $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its offiners, employees, agents, volunteers, and representatives are included as additional insureds (except Workers' Compensation) where required by written contract. This insurance is
<br />gat
<br />primary and non-contributory over any existing insurance and limited to liability arisi of the operations he named insured and where required by written contract.
<br />CERTIFICATE HOLDER zeb'N`P vw CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza M-23
<br />�11�✓
<br />'S_
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />Pamela Petersen.,
<br />ACORD 25 (2016/03)
<br />@ 1988.2016 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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