SASSOON, MAUREEN, DR., MS, MPH - Laserfiche WebLink

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ACORD 25 (2016103) DRMAU-1 CERTIFICATE OF LIABILITY INSURANCE I DA^'(MWDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer darts to the certificate holder in lieu of such endorsement(s). Brokers INSURED Dr. Maureen Sassoon P O Box 2028 Palos Verdes Peninsula, CA 90274 INC. .g u: 310.524-1357 �vc ,Nv1,949-313-3323 CAoMSS, carole.ml�hell@sig.us INSUNER(S) AFFORDING COVERAGE._. NAICB INSURER A: Westchester Surplus Lines Ins_ _ ,10172 INSURER e : INSURER C : INSURER 0: E rout --Donee reor.nrArc Unseneo. 1 ncv(mnM un uDr_n. 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MBR TYPE OF INSURANCE ISSRDDL,'UPOLICY NUMBER POLICY EFF POLICY UP LIMITS A X COMMERCML GENERAL UARRITY EACH OCCURRENCE IS 1,000.000 . CLMMS-MAOE ix, 1 OCCUR y Y G24270427008 OT/0112019 07/01/2020 DAMAGE TO RENT°i S 50,000 MED EXP(Any one pamml ;S 5,000 X Prof 8, P011ut-CLM 1,000,000 PFRSONAL A ADV INAIRY S (it: NL AGGHIrGATF LIMIT APPI. IESPERI GFNFRALAGGREGATE S 2,000,000 X POLICY jCa LOC PRODUCTS -COMPIOP AGO IS 2,000.000 _ -IS I (nlFl AUTOMOOILELIABWTY COMBINED SINGLE LIMIT ISFA Err.Mem1_ S.. ANY AUTO BOmLY INJVRY (Pe[pgSPP) 5 OWNED SCHEDULED AUTOS ONLY AUTO.pSSWWqq BODILY INJURY(P., amMMl) S ,.. .. AUM0.50N OY AUTOB P40FER Y DAMAGE ONLY . UMBRELLA LIAR IOCCUR EACH OCCURRENCE 5 EXCESS LVIB ICWMS-MADE ArngcgATF $ RETENTIONS A _ _DED J WORKERS CONVERSATION ANDEMPLOYERS' LIABILTY ", _ PI'It OTH- "rARHI" :FR YIN ANY "EXECUTIVE 'NIA F I. EACH ACCIDENT S ICEgqO,dPM,RITETO�RpENGWUEOi ImmMlory IA NH)---' F I. nISFASE - EA EMPLOYEE S II Vee, dssetlW pnMr __..... pFSC91PT10 OF OP RATIONR trhN FI. _DISFASE- LILY LIMIT S 'A Professional Llab 024270427008 07/01I2019 07I01/2020 Prof,Liab 1,000,000 A IContractore Poll 07/0112019 07/01/2020 Pollution 1,000,000 DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Addlllprwl Remarks Schetlulp, mry be slbchptl II mpro specs b unnlmdL Policy Provides 30 days 10 days for nonpayment REVIEWED & APPROVED notice of cancellation oxcept Endorsements Attached are Applicable where required by Written B RiSk MANAGEMENT DNIsION Contract.Cit, of Santa Ana, officers agents, employees and volunteers are named as additionally insured on I(As policy pursuant to written contract y agreement or memorandum of understanding. Such Insurance as is (NOTL) IN 20191Q RTIFI(:ATE HOLDER CSANTAA City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 1AUTHORQ-ED REPRESENTATIVE 91988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ....., I --.-..— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.