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MERCY -2 OP ID: SD
<br />,4Ill CERTIFICATE OF LIABILITY INSURANCE
<br />DATE0611212018 )
<br />06/12/2018
<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 />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />CONTACT
<br />NAME: Stephanie Dufour
<br />PHONE
<br />A/C. Ext). 714-369-2998 pIC Na; 714-840.6357
<br />E-MAIL hanie
<br />ADDRESS: Ste P @dufourinsurance.com
<br />INSURER(S) AFFORDING COVERAGE NAICif
<br />INSURER A: Great American Insurance Coma 16691
<br />INSURED Mercy House Living Centers
<br />P.O. Box 1905
<br />Santa Ana, CA 92702
<br />INSURER B: Great American Insurance Compa 16691
<br />INSURER C: NOVA Casualty Company 42552
<br />INSURER D: Great American Insurance Group 37532
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I OCCUR
<br />INSURER E: Philadelphia Indemnity 18058
<br />INSURER F:
<br />05/02/2018
<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 />/LTR
<br />TYPE OF INSURANCE
<br />D
<br />SOUR
<br />POLICYNUMBER
<br />MMIDBE
<br />DV
<br />EXP
<br />MMIDOV
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I OCCUR
<br />Y
<br />PAC426088203
<br />05/02/2018
<br />05/02/2019
<br />PREMISES Ea occurrence $ 100,00
<br />MED EXP (Any one person) $ 10,000
<br />A
<br />X Prof. Liability
<br />PAC426088203
<br />05/02/2018
<br />05/02/2019
<br />PERSONAL &ADV INJURY $ 1,000,00
<br />X Sex Abuse/Miscond
<br />GENERALAGGREGATE $ 2,000,00
<br />A
<br />PAC426088203
<br />05/02/2018
<br />05/02/2019
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />PRO F
<br />X POLICY IFC LOC
<br />Ded.- $0 $
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident 1,000,00
<br />AJ
<br />AUTO
<br />Y
<br />CAP 188045404
<br />05/0212018
<br />05/02/2019
<br />BODILY INJURY (Per person) $
<br />AOX SCHEDULED
<br />AUTOS AUTOS
<br />Per accident $
<br />BODILY INJURY ( )
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $ 130,00
<br />PER ACCIDENT
<br />Comp/Coll Ded. $ 50
<br />J(
<br />UMBRELLA LIAB X
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,00
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Y
<br />UMB 426088303
<br />05/02/2018
<br />05/02/2019
<br />AGGREGATE $ 4,000,00
<br />DED I X I RETENTION 10000
<br />$
<br />C
<br />E
<br />WORKERS COMPENSATION
<br />ANDEMPLOVERS'LIABILITY VIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />(MandatoryEMBER in NH ExcwoeD? ❑NIA
<br />( rY )
<br />If yes,
<br />CFI -WK -10000043.00
<br />(ACCIDENT)
<br />ACCIDENT PHLY78928850
<br />02/08/2018
<br />11/21/2017
<br />02/08/2019
<br />11/21/2018
<br />X WC STATU- X OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE $ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION
<br />D
<br />Cyber Liability
<br />Y
<br />NLP3642944
<br />01/29/2018
<br />01/29/2019
<br />Per Occ 1,000,00
<br />E
<br />D&O/ EPLI
<br />Y
<br />PHSD1173663
<br />10/17/2018
<br />10/17/2019
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 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 6 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 />r 'J
<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 CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD CORPORATION. All rici
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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