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LAURA-1 OP ID: SH '4? °--R° CERTIFICATE OF LIABILITY INSURANCE 4 DAT D/YYYY) .,. . 0 8/31 08/31 /12 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 policy(ies) must 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER 949-253-8000 CONTACT NAME: Shelly Hehner Friedmann & Friedmann Ins Svcs CA License #0759373 949-253-8009 HONE No. EXt , 949-417-2641 A/C No): 949-253-8009 3990 Westerly Place Suite 100 N B h CA E-MAIL shell fandfins.com ADDRESS: y@ --- ewport , eac 92660 Laverne Friedmann INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co 16535 INSURED Laura's House INSURER B : _ Laura Kelly - - - 999 Corporate Drive, Suite 225 INSURER C : Ladera Ranch, CA 92694 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER! 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. ----- - ------ -- INSR LTR ' ' TYPE OF INSURANCE ADDL SUBR ---- POLICY EFF POLICY NUMBER MM/DDIYYYY POLICY EXP MMIDD/YYYY -"--- LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY X RENTED DAMAG O PREMISES Ea occurrence -- $ J CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG '.. $ POLICY PRO T $ --_-- LOC JEC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT F Ea accident) $ ANY AUTO - BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS ' BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Peraccident) - - - - -- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y /" OFFICER/MEMBER EXCLUDED? ? N/A WC684064500 09101/12 09101/13 E.L. EACH ACCIDENT ---_- $ 1,000,000 $ (Mandatory in NH) _ E.L. DISEASE - EA EMPLOYE $ 1,000,000 I If yes. describe under - - _ ....- - - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 i I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Emergency Shelter Grant Funds (ESG) LAIN rl_l_AI JUN CITYS-8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Development Department M-25 20 Civic Center Plaza, 6th Fl AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 i/l y':f © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD