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ORANGE COAST INTERFAITH 3
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ORANGE COAST INTERFAITH 3
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Entry Properties
Last modified
8/23/2021 2:46:13 PM
Creation date
12/8/2004 12:57:50 PM
Metadata
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Template:
Contracts
Company Name
Orange Coast Interfaith Shelter
Contract #
A-2004-087-30
Agency
Community Development
Council Approval Date
5/3/2004
Expiration Date
6/30/2005
Insurance Exp Date
1/17/2005
Destruction Year
2010
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AcoM <br />CERTIFICATE <br />N LIABILITY <br />INSURAN _E Ol/30/2004 DATE0/2004 <br />PRODUCER (916) 784-9070 <br />All -Cal Insurance Agency <br />801 Riverside Avenue <br />Suite #105 <br />Roseville CA 95678- <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />ORANGE COAST <br />1963 WALLACE <br />COSTA MESA <br />INTERFAITH SHELTER <br />AVENUE <br />CA 92627- <br />INSURERA: Nonprofits IRS Alliance <br />INSURER B: <br />INSURER C: <br />INSURER <br />INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />AWL <br />INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLK: EFFECTIVE <br />DATE(MMNOM!) <br />POLICY EXPIRAT DH <br />DATE(MMA)OTY) <br />LIMITS <br />A <br />GENERAL LIABILITY <br />/ / <br />/ / <br />EACH OCCURRENCE <br />S 1,000,000 <br />MERCIAL GENERAL LIABILITY <br />4x—.cj-CLAIMS MADE OCCUR <br />2004-02187 <br />01/17/2004 <br />01/17/2005 <br />DAMAGE TO RENTED <br />oraa,Mra PREMISES Ea <br />i 50,000 <br />MED Up Ift one aon <br />$ 5,000 <br />PERSONAL B ADV INJURY <br />S 1,000,000 <br />OFESSIONAL LIAR. <br />Xj <br />IMPROPER 9EXDAL CON <br />GENERALAGGREGATE <br />S 2,000,000 <br />/ / <br />/ / <br />GEN'LAGGREGATE <br />POLICY <br />LIMRMPLIES PER: <br />JECT LOC <br />PRODUCTS - COMPMP AGG <br />S 2,000,000 <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />/ / <br />/ / <br />COMBINED SINGLE LIMIT <br />(Eetxiaenp <br />$ 1,000,000 <br />X <br />X <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />2004-02187 <br />01/17/2004 <br />01/17/2005 <br />BODILY INJURY <br />(Pa Pawn) <br />$ <br />BODILY INJURY <br />(pa a '"m) <br />S <br />HIREDAUTOS <br />NON,OVMEDAUTOS <br />/ / <br />/ / <br />PROPERTY DAMAGE <br />(Per eac N) <br />S <br />GARAGE LIABILITY <br />AUTO ONLY -EA ACCIDENT <br />$ <br />ANY AUTO-/ <br />t, <br />�S iS�j'J s, <br />/ <br />/ / <br />OTHER THAN FA ACC <br />AUTO ONLY. <br />AGG <br />S <br />$ <br />EXCESSNMBRELLA LIABILITY <br />OCCUR CIAI.SMADE <br />DEDUCTIBLEI`p <br />q <br />\JV'-C" J l f <br />/ / <br />/ / <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />S <br />S <br />RETENTION S <br />WORKERS CCMPENSATION AND <br />EMPLOYERS' LABILITY <br />/ / <br />/ / <br />TT <br />TORY LIAMRS ER <br />E.L. EACH ACCIDENT <br />S <br />ANY PROPRIETORRARTNEREXECUTNE <br />OFFICERMEMSER EXCLUDED) <br />If,., Ueavaeu _ <br />/ <br />EL DISEASE -EA EMPLOYEES <br />ELDISEASE-POLICYLIMIT <br />$ <br />SPECIAL PROVISIONS I»Ivv <br />- <br />DESCRIPTION OF OPERATIONSLOCATIOMSNEHICLESRXCWSICNS ADDED BY ENDORSEMENTSPECIAL PROVISIONS <br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INURED AS A <br />FUNDING SOURCE TO THE INSURED UNDER THIS AGREEMENT. FORM CG 2026 APPLIES. <br />( ) - (714) 647-6549 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER HALL XKWaXWX= MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />CITY OF SANTA ANA )1()t�tpp}E#��gpp��(py(g1g7E <br />CC144MITY DEVELOPMENT AGENCY <br />P.O. BOX 1988 AUTHORIZED REPR NTATNE <br />SANTA ANA CA 92702- <br />ApCORD 25 (2001/08) ^� D CORPORATION 1988 <br />I'6� INS025(010SLo5 ELECTRONIC LASER FORMS, INC. -(BW)3 A5 ,U Pagel Tl <br />
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