|
LEGAL -3 OR ID: JM
<br />�--�" CERTIFICATE OF LIABILITY INSURANCE
<br />O09(M MIDDIYY
<br />/19/201 7 )
<br />09/19!27
<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 pollcy(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 />Rancho Mesa Insurance Services
<br />280 Riverview Parkway #401
<br />CONTACT
<br />NAME:
<br />_-.
<br />PH o Ext : I INC.Nor
<br />_
<br />E-MAIL
<br />ADDRESS:
<br />Santee, CA 92071
<br />INSURER(S) AFFORDING COVERAGE
<br />_
<br />NAICp
<br />_
<br />INSURER A . Markel Insurance Company
<br />_
<br />38970
<br />INSURED Legal Aid Society of Orange
<br />INSURER B: New York Marine a Sen'I ins Co
<br />18808
<br />County
<br />2101 North Tustin Avenue
<br />INSURERC:
<br />CLAIMS -MADE FXIOCCUR
<br />INSURER D:
<br />Santa Ana, CA 92705
<br />_
<br />INSURER E'
<br />I PREMISES IEa occurrence)
<br />MED EXP (Any onepers�$
<br />�S
<br />INSURER F'
<br />COVERAGES CERTIFICATE NUMBER: 1 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />IN
<br />SUBR
<br />POLICYNOMBER
<br />POLICY EFF
<br />MMIDDIYYYV
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CN
<br />:.SANTA ANA CA 92701
<br />.N _-
<br />EAGH OCCURRENCE
<br />$ 1,000,00
<br />CLAIMS -MADE FXIOCCUR
<br />X
<br />!HUP2133-01
<br />07/01/2017107101121)18
<br />I PREMISES IEa occurrence)
<br />MED EXP (Any onepers�$
<br />�S
<br />$ 1,000,00
<br />10,00
<br />PERSONAL B ADV INJURY
<br />1,000,00
<br />LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />2,000,00
<br />.GEN'LAGGRE�GATE
<br />POLICY LJ JECOT LX�LOC
<br />__$
<br />PRODUCTS -C
<br />$ 2,000,00
<br />$
<br />OTHER:
<br />Aj�ANY
<br />AUTOMOBILE
<br />LIABILITY
<br />AUTO
<br />j
<br />HUP2133-01
<br />107/01/2017
<br />07/01/2018
<br />COMB I NEDSINGLE LIMIT
<br />fr... an
<br />$ 1,000,00
<br />_
<br />BODILY INJURY (Perp ... N
<br />_
<br />$
<br />_
<br />{
<br />X
<br />ALLOWNED 1 SCHEDULED
<br />AUTOS AUTOS
<br />X I NON -OWNED
<br />HIRED AUTOS AUTOS
<br />!
<br />I
<br />-
<br />BODILYINJURY(Peraocitleuh
<br />S
<br />_ _
<br />I PROPERTY DAMAGE
<br />Per eccirlent
<br />$
<br />X
<br />I
<br />UMBRELLALIAB � OCCUR
<br />I
<br />EACH OCCURRENCE
<br />_. _.
<br />S 2,000,00
<br />I
<br />Excess uae cLAIMs-MAGE
<br />HW2134-01
<br />, 07/01/2017
<br />07/01/2018
<br />AGGREGATE
<br />y 2,000,00
<br />-
<br />_
<br />DED X I RETENTION$ 10,000
<br />�$
<br />B
<br />' WORKERS
<br />ANDEMPLOYERS'LIABILITY
<br />I ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBEREXCLUDED4
<br />(MandatoryinNH)
<br />NIA
<br />WC201700015159
<br />09/01/2017
<br />09101/2018
<br />PER OT -
<br />X
<br />,STATUTE
<br />EL. EACHACCIDENT
<br />—'--'-"-- -—
<br />EL.DISEARE-EA EMPLOYE
<br />I $ 1,000,00
<br />$ 1,000,00
<br />sc
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS bue,y
<br />E.L. DISEASE-POLICV LIMIT
<br />$ 1,000,00
<br />A
<br />Sexual Abuse and
<br />HUP2133-01
<br />07/01/2017
<br />07/0112018
<br />IPer Polic 2,000,00
<br />Molestation Liab
<br />HUP2133-01
<br />i
<br />;Per Prsn 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
<br />RE: OPERATIONS OF THE NAMED INSURED AS CERTIFICATE HOLDERS INTEREST MAY NaC.3}rt%V�
<br />APPEAR SUBJECT TO POLICY TERMS, CONDITIONS, AND EXCLUSIONS. CERTIFICATE'
<br />HOLDER IS INCLUDED AS ADDITIONAL INSURED PER FORM MGL 1242 03 14 ATTACHED.
<br />—F
<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTAA2
<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 />CITY OF SANTA ANA
<br />ITS OFFICERS, AGENTS, AND
<br />AUTHORIZED REPRESENTATIVE
<br />EMPLOYEES AND VOLUNTEERS
<br />20 CIVIC CENTER PLAZA
<br />CN
<br />:.SANTA ANA CA 92701
<br />.N _-
<br />ACORD 25 (2014/01)
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|