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MERCY4 OP ID: SO <br />,4`oizo, CERTIFICATE OF LIABILITY INSURANCE <br />DA05/171o019 <br />05/17/2019 <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(ies) 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 Stephanie Dufour <br />n o" o e , 714-369-2998 AAC No): 714-840-6357 <br />E-MAIL P <br />ADDRESS: Ste hanie dufourinsurance.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Philadelphia Indemnity <br />18058 <br />INSURED Mercy House Living Centers <br />P.O. Box 1905 <br />Santa Ana, CA 92702 <br />INSURER B: Philadelphia Indemnity <br />18058 <br />INSURERC:NOVA Casualty Company <br />42552 <br />INSURER D : Philadelphia Indemnity <br />18058 <br />INSURER E: Philadelphia Indemnity <br />18058 <br />INSURER F: <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 />INSR <br />TR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMIDDY� <br />MM/DDY� <br />LIMITS <br />A <br />A <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X Prof. Liability <br />PHPKI976777 <br />PHPKI976777 <br />PHPK1976777 <br />0510212019 <br />05/0212019 <br />05/0212019 <br />05/0212020 <br />05/0212020 <br />05/02/2020 <br />EACH OCCURRENCE <br />$ 1,000,00 <br />PREMISES Ea occuvence <br />$ 100,00 <br />MED EXP(Any one person) <br />$ 10,00 <br />PERSONAL& ADV INJURY <br />$ 1,000,00 <br />X <br />Sex Abuse/Miscond <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />GEN'L AGGREGATE <br />X POLICY <br />LIMIT APPLIES PER: <br />PRO LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,00 <br />Ded: $0 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS X AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />PHPK1976777 <br />0510212019 <br />0510212020 <br />Ea OMRIcitlNED SINGLE LIMIT <br />acent <br />1,000,00 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />PERACCIDENT <br />$ 130,00 <br />Comp/Coll Ded. <br />$ 50 <br />B <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />PHUB674538 <br />05/0212019 <br />0510212020 <br />EACH OCCURRENCE <br />$ 5,000,00 <br />AGGREGATE <br />$ 5,000,00 <br />DIED I X RETENTION$ 10000 <br />$ <br />C <br />E <br />WORKERS COMPENSATION <br />ANO EMPLOYERS' LIABILITY <br />ANY PROPRIETOMPARTNER/EXECUTIVE Y/" <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatary in NH) <br />Use, describe under <br />SCRIPTION OF OPERATIONS below <br />NIA <br />CF1-WK-10000043-03 <br />(ACCIDENT) PHLY78928850 <br />02108/2019 <br />11/2112018 <br />02/08/2020 <br />1112112019 <br />X WC STATU- X TH- <br />TORV LIMITS <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,00 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,00 <br />D <br />E <br />Cyber Liability <br />D&O/EPLI <br />NLP3642944 <br />PHSD1173663 <br />01129/2019 <br />1011712018 <br />01/2912020 <br />10/17/2019 <br />Per Occ 1,000,00 <br />Aggregate 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />CERTIFICATE HOLDER CANCELLATION <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 />1 <br />ACORD 25 (2010/05) <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />M <br />