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MERCY -2 OP ID: SD
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />1
<br />TO WHICH THIS
<br />06/78/16/2001717
<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 />CONT Stephanie Dufour
<br />uittler once Services, LLC
<br />561Duf1
<br />5891 Littler Drive
<br />PHONE 714-369-2998��FAX 714-840.6357
<br />A c N lr (Arc. Ne):
<br />E71 Ste hanie anie@dufourinsurance.com
<br />AODREB,'MAp
<br />Huntington Beach, CA 92649
<br />Dufour
<br />_
<br />_
<br />$ 10,000
<br />INSURER(S)AFFORDING COVERAGE NAICN
<br />PERSONAL& ADV INJURY
<br />INSURER A: Great American Insurance Com a
<br />INSURED Mercy House Living Centers
<br />INSURER B: Great American Insurance Compa
<br />P.O. Box 1905
<br />INSURER C : NOVA Casualty Company
<br />Santa Ana, CA 92702
<br />-
<br />IF
<br />X POLICY 1 RO LOC
<br />_ D : Grea_t American Insurance Group
<br />INSURER
<br />$
<br />INSURER E:
<br />INSURER F:
<br />$ 1,000,00
<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
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />Frank Hernandez
<br />INSR TYPE OF INSURANCE POLICY NUMBER MWODYMW " POLI — $ MM1BE YYY
<br />LIMITS
<br />Santa Ana, CA 92702
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A X COMMERCIAL GENERAL LIABILITY X PAC426-08.82 05/02/2017 05102/2018
<br />PREMISES Eaoccurrence
<br />$ 100,00
<br />CLAIM54ADE OCCUR
<br />__.
<br />MEDEXPVAYeronaocn)
<br />_
<br />$ 10,000
<br />A X Prof. Liability PAC426.08.82 05/0212017 05/02/2018
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />A X Sex Abuse/Miscond PAC426.08.82 05/02/2017 05/02/2018
<br />GENERALAGGREGATE
<br />$ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS -COMPIOP AGO
<br />$ 2,000,00
<br />IF
<br />X POLICY 1 RO LOC
<br />Dad: $0
<br />$
<br />AUTOMOBILE LIABILITY
<br />COM INEDSIN L LIMIT
<br />Ea accident
<br />$ 1,000,00
<br />A ANY AUTO X CAP 188045401 05/0212017 05102!2018
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED X SCHEDULED
<br />BODIt.Y INJURY (Por acctdenQ
<br />$
<br />AUTOS AVTOS
<br />X NON -OWNED
<br />PF ACCI�ENJ
<br />$ 130,000
<br />X HIRED AUTOS AUTOS
<br />�......_
<br />ComplColl Ded.
<br />$ 5010
<br />X
<br />UMBRELLA UAB X OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,00
<br />B,
<br />EXCESS LIAB CLAIMS -MADE X UMB 4260883 05/02/2017 05/02/2018
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X RETENTION$ 10000
<br />$
<br />WORKERS COMPENSATION
<br />X WC STINT T- TH-
<br />AND EMPLOYERS' LIABILITY
<br />C ANY PROPRIETCWPARTNERIEXEGUTIVEY� CF1-WK-10000043.00 02/08/2017 02/08/2018
<br />E.L. EACH ACCIDENT
<br />"
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED? NIA
<br />(Mandatory in NH)
<br />EL, DISEASE - EA EMPLOYE-
<br />$ 1,000,00
<br />If yes. essence carder
<br />DESCRIPTION OF OPERATIONS below
<br />EL DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />D Cyber Liability X NLP3642944 01/29/2017 01/29/2018
<br />Per ODD
<br />1,000,000
<br />X
<br />Aggregate
<br />9,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach AC ORD 101, Additional Remarks Schedule, If more space Is required)
<br />Re: CDBG, 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 />CFRTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<br />D 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Y of
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Frank Hernandez
<br />20 Civic Center Plaza Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010/05)
<br />D 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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