Laserfiche WebLink
,aco CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />Pauma/Valley Insurance Agency, Inc. NAONE <br />ME: Jenny BOUIOS <br />P.O. Box 1530 (AtHCC. Ext : (760)749-2383 P.O. FAX No : (760)751-7692 <br />Valley Center, CA 92082 E-MAIL <br />ADDREss: jenny@pvins.com <br />License #: 0662677 INSURERS AFFORDING COVERAGE NAIC # <br />w . w INSUITB"itaI&ar.wionAwwnamr"merica 119046 <br />Crtger Care Center Inc INSURER C: <br />2440 River Rd Ste 130 INSURER D : <br />Norco, CA 92860-2402 INSURERE: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 03004613-352359 REVISION NUMBER: 4 <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 POLTYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DID YCY EYYY MM/DD YFF POLICY EXP LIMITS <br />LTR IN D WVD <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />680A1485981 <br />09/24/2024 <br />09/24/2025 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />CLAIMS -MADE X OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 300,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 4,000,000 <br />X POLICY jE LOC <br />PRODUCTS - COMP/OP AGG <br />$ 4,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />68OA1485981 <br />09/24/2024 <br />09/24/2025 <br />EOaccidentBINED SINGLE LIMIT <br />$ 2,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY X AUTOS ONLY <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />B <br />AND EMPLOYERS' LIABILITY WORKERS COMPENSATION <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ H <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />N / A <br />EIG485284803 <br />09/22/2024 <br />09/22/2025 <br />OT <br />X STATUTE ERH <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />If describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />A <br />Professional Liab <br />68OA1485981 09/24/2024 09/24/2025 Aggregate <br />$4,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured as required in written <br />agreement per attached endorsement. (CG T1 00 02 19). Waiver of subrogation applies per attached endorsement. (CG D8 42 <br />02 19). 30* Day Notice of Cancellation 10* day Notice of Cancellation for Cancellation for Non -Payment of Premium. <br />(Endorsement to follow). This policy is primary and non-contributory as required in written agreement per attached <br />endorsement. (CG T1 00 02 19). <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRI <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NO Risk Mwaganent DiAsian <br />ACCORDANCE WITH THE POLICY PRC <br />Risk Management Division 3- REVIEWED&APPROVED BY: <br />20 Civic Center Plaza 4th Floor <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 ®' Risk Management Specialist <br />�,ruw�- VO"U-e0"4 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by JEN on 10/02/2024 at 11:OOAM <br />