|
ACQ MERCY-2 OP 10: $0
<br />�.... CERTIFICATE OF LIAaILITY IN.qIIR®IJI-'= I DATa(MIAMO/Y"
<br />7126/2.
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON019
<br />LY AND
<br />CONFERS NO RIGHTS UPON THE CERTIFICATE H THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />BELOW,
<br />POLICIES
<br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORVEp
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: It the ceniBCate holder IS an ADDITIONAL INSURED, the pollty(tes) must be e111: 1 1 d, H SUBROGATION IS WAIVED, sub)eat to
<br />the terms and conditions of the policy, certain policies may require an
<br />endorsement, A statement on this cartlgcato does not confer rights to the
<br />oortigcato holder In lieu of such andorsemant s ,
<br />PRODufour Insurance
<br />NAME Stephanie Dufour
<br />6611LitlerDriveServicae,LLC
<br />Huntngtor Drive
<br />Huntington Beach, CA92648�
<br />_ _
<br />��
<br />c s, .714-SS9.2998 t c Nor 714- 40.83S7
<br />Stephanie Dufour
<br />ADpNE89 Ste phanie(�dufourinauranca,aom
<br />INSURERIBI, AFFORDING COVERAGE._. NAN7,f
<br />INSURED erC 0U8e Living Centers i
<br />y
<br />P.O. Box 1905
<br />IN$DRERA,Phiiadei hIa IndBmni 18058
<br />NSUREReIPhiladelehla Indemnl
<br />_ 18068
<br />Santa Ana, CA 92702
<br />INSURERc I NOVA Casual Company
<br />42652
<br />mauaaa U I Philadelphia Indemnity
<br />18058
<br />INsOREk a,c Phl. ladelphia Indemnity
<br />98gg8
<br />COVERAGES CMIR-1'IF11-TG arl lumen.
<br />THIS
<br />INDICATEO,
<br />IS TO CERTIFY THAT THE POLICIES
<br />OF
<br />INSURANCE
<br />LISTED BELOW HAVE BEEN.ISSUED
<br />TO
<br />THE INSUREOEN�ASION
<br />NUMBER:
<br />' I ABOVE. FOR THE
<br />POLICY
<br />CERTIFICATE
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />MAY SE ISSUED OR MAY
<br />PERTAIN,
<br />TERM OR CONDITION OF ANY
<br />THE INSURANCE AFFORDED BY
<br />CONTRACTOR
<br />THE POLICIES
<br />OTHER
<br />DOCUMENT WITH RESPECT
<br />PERI00
<br />TO WHICH THIS
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH
<br />POLICIES.
<br />LIMITS SHOWN MAY HAVE BEEN
<br />RECUCEO BY
<br />DESCRIBED
<br />PAID
<br />HEREIN IS SUS ECT TO
<br />ALL RM
<br />THE TE S.
<br />CLAIMS,
<br />LTn
<br />TYPE OrINSVRANeE'.
<br />POLICY NUMBER
<br />M
<br />.P..
<br />..
<br />LIMITS
<br />`....
<br />eENERAL LIABILITY
<br />A
<br />X"
<br />X
<br />X
<br />PHPK1978777
<br />05/02/2019
<br />05/02l2020
<br />EACH OCCURS ENDS
<br />b 1,000,00
<br />CIAIOWGENEMLLIABIi.ITY
<br />CtAIMS•lAAOE aOOCUR
<br />EMI$ 6 a men
<br />S 100,00
<br />MED E%P (AnYTrM Wreon)
<br />PERSONAI.SADVWJURY
<br />S iQ,00
<br />A
<br />X Prof, Liability
<br />PHPKI976777
<br />0610212019105/02/2020
<br />X
<br />SaxAbu$alMiacond
<br />A
<br />pHpK1978777
<br />OB/A2/2019
<br />05/0212020
<br />_
<br />GEN'L AGGREGAE LIMIT APPLIES PER; a
<br />pENERALAGGREOATE
<br />y 2,000,00
<br />PRODUCTS :OOMplOP ADD
<br />$ $000,00
<br />X POLICY ! R L00
<br />Ded,• $0
<br />$
<br />AUTOMOBILE LIABILITY
<br />I
<br />A
<br />� ANYAUTo
<br />AU.OWN06102f2019
<br />AUr EO X SCHHEEDULED
<br />X X AUU?UTTO$ WNEDp
<br />X.I
<br />X
<br />PHPKI976M
<br />OBIOPJ2020
<br />§S aDISIN -I.I
<br />; 1100 101
<br />�—
<br />BODILY INJURY (For person)
<br />BODILY INJURY IPararAdnnO
<br />$
<br />$ �'
<br />HIREDANTD$
<br />R E IDES E
<br />S � 130,00
<br />XUMBRELLA LIAB XOOIjIJN
<br />:Com 1CDIi Ded•.
<br />EACH OCCURRENCE_
<br />3 So
<br />5,000,00
<br />B
<br />E0aE30UA9 CLAIMS -MADE
<br />X
<br />X
<br />P1I1.18674538
<br />05/0212019
<br />06/02/2020
<br />DEB X R E 10000
<br />X
<br />GPi•WK•1900094343
<br />i
<br />AGGaEGATE
<br />S 5,000,00
<br />C
<br />n1QNf
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY ECUTIVE Y�
<br />X 0STATU• X OT
<br />t
<br />E
<br />CTIICRAIM MNORE CCLUDERO
<br />MIA
<br />02/061201910210812020
<br />E.L.FADHAODIDENT
<br />$ 1,000,00
<br />(MendI In NH)
<br />9-deeullkuhdw
<br />!(ACCIDENT)
<br />PHLY7892886R
<br />11121/2019
<br />11/21l2018
<br />E,L_DISEASE• PA EMPLOYE
<br />t 1,000,00
<br />15
<br />DE er OFOPEM7 NS
<br />&OIEPLI eblli(y
<br />X
<br />X
<br />NLP3642044
<br />o1129/20i9
<br />01/29/2020
<br />E.L. DISEASE-p041CY LIMIT
<br />Per Occ
<br />3 4,000,00
<br />E
<br />D8:01EP
<br />X
<br />X
<br />PHS01973663
<br />1011712018
<br />10/17/2019
<br />Aggregate
<br />1,000,e0
<br />100000
<br />DBSCRIPTN)N OFOPERATIONS! LOCATIONS / VOM13LIO (AMaoh A0OR0101, Addaional Ramme Sohedule, N more $W' '; ulredl
<br />City of Santa Ana, its officers employess, agents, volunteers and
<br />representatives are named
<br />additional insureda with respect to the operations
<br />of the named insured 8 this policy is primary par the attached endorsement.
<br />Narkes
<br />onmpennation waiver of subrogation included. 30 days notice of
<br />cancaliation for non-payment of preacitun,
<br />REVIEWED & APPROVED
<br />By f21c1_Ma A n1I45l()ru
<br />icy, pNT
<br />RF0TIMIraTc O c _..
<br />062019
<br />City of Santa Ana
<br />Risk Management Div
<br />20 Civic Center Plaza,
<br />Santa Ana, CA 92702
<br />DATE
<br />AUTHORIZED REPRESENTATIVE
<br />0
<br />ES BE CANCELLED BEFORE
<br />WILL BE DELIVERED IN
<br />resarved
<br />•-, ,,.o....w. w name ana logo are registered marks of ACORD
<br />
|