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Last modified
7/8/2020 4:18:19 PM
Creation date
7/6/2018 9:24:57 AM
Metadata
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Template:
Contracts
Company Name
SECOND CHANCE
Contract #
A-2018-135-23
Agency
COMMUNITY DEVELOPMENT
Council Approval Date
5/15/2018
Expiration Date
6/30/2019
Insurance Exp Date
9/14/2018
Destruction Year
2024
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CERTIFICATE OF LIABILITY INSURANCE <br />°A06120/2o9&YYY' <br />THISCERTIFICATE ISISSUEDASAMATTEROPINFORMATIONONLYAND OONFEASNO RIGHTS UPON.THECERTIFICATe HQLDER.TNIS CErflri ATEDOESNOTAFFIRMATIVBLYOR NEGATIVELY <br />AMEND, EXTEND ORALTERTHECOVERAGE AFFORDED BYTHE POLICIES SELOW.7H15CERTIFICATE OF INSURANCE DOES NOT CONSHTUTEACONTRACT BETWEEN THE ISSUING INSIIRER(s), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTNB CERTIFICATE HOLDER. <br />IMPORTANT: IFthe coruscate holder is an ADDITIONAL INSURED, Ole PWICyO(f) must have ADDITIONAL INSURED provislom or be endorsed. RSUBROGARON IS WAIVED, subjectto the terms and <br />conditions ofthe POICY, certain Pullet" may require an" comment. A statement an this continues does not confer rights W the certificate holder In IIW ofsuch endursetnanr(s). <br />PRODUCER <br />CONTACT f <br />Chuck Hyneman <br />18371-A Lemon Drive ✓ <br />NAME: Chuck Hynaman <br />PHONE ✓ <br />(A/C, NO, EXTX 714-777.9823 <br />FAX <br />(A/C, No): 714-777-9898 <br />Yorba Linde, CA 92886 <br />EMAIL <br />ADDRESS: <br />INSURER(E)AMORDINGOOVERAGE <br />NAICR <br />INSURED <br />INSURERA. United States Liability Insurance Company 1,> <br />Second Chance Orange County <br />2618 San Miguel Drk284 <br />Newport Beach, CA 92600 <br />INSURER$: Slate Fund InsuranCe <br />INSURERCI <br />INSURER D: <br />INSURERES <br />INSURERF. <br />COVERAGES CERRFICATENUNl REVISION NUMBER: <br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY <br />REgUIREMEKTERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED ORMAYPERTAIN. THE INSURANCE AFFORDED BY THE <br />POLICIES DESCRIBED HEREIN. IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES: LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPEORINSURANCR <br />- - <br />ADDTL <br />INSD <br />SUER <br />WVO <br />p4LICYNUMSER <br />POUCYEFF <br />(MMIDD/YYYY) <br />POUCYEXP <br />(MM/DD/YYYY) <br />LlArftb <br />MERCIACENERALLIASILITY <br />EACHOCCURRENCE <br />s 1(000,00 <br />CLAIMS -MADE OCCUR <br />N11 <br />bAMAGETORENTED <br />PREMISES (Ed Occurrence) <br />§ 100,00 <br />MEDEXPOAronPperson) <br />$ 500 <br />PERSONALBADVINJURY <br />S 1,000,00. <br />Y <br />NPP1678341 <br />06/20/2018 <br />09/14/2018 <br />GGREGATE LIMTTAPPUES PER: <br />GENERALAGGREGATE <br />§ 2000,00 <br />POLICY ❑ PROJECT a LOC <br />PRODUCTS- COMP/OP AGG <br />$ Included <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINEDSINGLEUMR <br />(EaattitlenU <br />It 100000 <br />BODRYINJURY(Perpareon) <br />S <br />ANYAUTO <br />BODILY INIURY(peraccWanJ <br />§ <br />A <br />OWNEDAU70S SCHEDULED <br />ONLY AU135 <br />NPP1678341 <br />06AV2018 <br />09/14/2018 <br />PROPERTY DAMAGE <br />(Peraecident) <br />$ <br />HIREDAUTOS X NON-0WNED <br />ON IY AUTOSONLY <br />UMBRELtALUB <br />QCCUR <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />f <br />EXCESSUAB <br />CLAIMS -MADE <br />DEp I I RETENTIONS <br />§ <br />WORXERSCOMPENSATION <br />ANDEMPLOYERS"LLMBILRY <br />PER <br />STATUTE <br />OTHER <br />$ <br />B <br />ANY PROPRIETOR/PARTNER/ YIN <br />EXECIrTIVE OFFICER/MEMBER9226837-18 <br />EXCLUDED7(Mandatory In NH) <br />N/A <br />08/2012018 <br />03/01/2019 <br />E.LEACHACCIDENT <br />f 1,000,000 <br />E.L. DISEASE -EAEMPLOYEE 1,400,00 <br />E.L.DISEASE - POLICY LIMIT <br />s 1,000,000 <br />IfMPEdescribe <br />eunder DESCRIPTION ORATION <br />A <br />Professional E&O Liability <br />NPP1578341 <br />06120/2016 <br />09/1412018 <br />$1,000,000-Each <br />Incklen <br />$2,000,D60- <br />Agmgeta <br />DESCRIPTION OF OPERATION$/LOCATIONS/VEHICLES(ACORD 101, AddiUonat Romarks schedule, may be attached If more space is re iulmd) <br />Low, 1921 Saypolnto Drive, Newport Beach, CA 92660 <br />ddltional Insured: The City of Santa Ana <br />CERTIFICATENOLDER <br />20 Civic. Canter Plaza M-25 <br />Santa Ana, CA 92801 <br />ACORD 25 (2016/03) 01988-2015AC6RD CORPORATION. All Rights Reserved <br />314769 11-15 The ACORD name and logo are registered marks of ACORD <br />0 <br />1 <br />�J <br />
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