Laserfiche WebLink
7 <br />MERCY -2 OP ID: SD <br />'441. O CERTIFICATE OF LIABILITY INSURANCE <br />DATE(M11 /1YYY) <br />05/11/11 <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 endomemen s). <br />PRODUCER <br />Dufour Insurance Services, LLC 714- 369 -2998 <br />5611 Littler Drive 714 -840 -6357 <br />Huntington Beach, CA 92649 <br />Stephanie Dufour <br />CONTACT <br />NAME: Stephanie Dufour <br />arc °No E,): 714- 369 -2998 jac No): 714 -840 -6357 <br />E -MAIL h <br />ADDRESS: Ste p anie dufourinsurance.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Philadelphia Insurance Compani <br />LIMITS <br />INSURED Mercy House Transitional <br />Living Centers <br />P.O. Box 1905 <br />Santa Ana, CA 92702 <br />INSURERS: Seabright Insurance Company <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />$ 1,000,000 <br />INSURER F: <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR <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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBIR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR <br />X <br />PHPK714999 <br />05102/11 <br />05/02112 <br />PREMISES Ea occurrence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,00 <br />A <br />X Professional <br />PHPK714999 <br />05/02/11 <br />05/02/12 <br />PERSONAL BADVINJURY <br />$ 1,000,000 <br />X <br />Abuse <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />A <br />PHPK714999 <br />05/02/11 <br />05/02/12 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,000 <br />X POLICY PRO LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />(Ea O acciden SINGLE LIMIT <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANY AUTO <br />X <br />PHPK714999 <br />05/02/11 <br />05102112 <br />ALL OWNED X SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />X <br />BODILY INJURY Per accdent <br />( ) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />X <br />UMBRELLA LIN <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />AGGREGATE <br />$ 1,000,000 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />X <br />PHUB343841 <br />05102/11 <br />05/02/12 <br />DED I X I RETENTION $ 10000 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N /A <br />BB1113517 <br />02/08/11 <br />02/08/12 <br />WC STATU- OTH- <br />X TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS beli2x <br />A <br />Professional Liabi <br />PHPK714999 <br />05/02/11 <br />05102112 <br />Per Occ 1,000,00 <br />A <br />Abuse Liability <br />PHPK714999 <br />05102111 <br />05/02/12 <br />Aggregate 1,000,00 <br />®RNA <br />DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) t T'�"D .... <br />Re: CDBG, ESG, and HPRP grants. City of Santa Ana its officers, employees, IkO V <br />agents, volunteers and representatives are named additional insureds with MY <br />respect to the operations of the named insured & this policy is primary per <br />the attached endorsement. Workes compensation coverage excluded, evidence ���RGK <br />only. 10 days notice of cancellation for non - payment of premium. 115 �' Attorney <br />'SS1 a It City <br />A <br />City of Santa Ana <br />Frank Hernandez <br />20 Civic Center Plaza Box 1988 <br />Santa Ana, CA 92702 <br />L417 CL7.4 al W-1 <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 />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />