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ntr 141511110 0 K0111
<br />A LX CERTIFICATE OF LIABILITY INSURANCE
<br />DAT5Yt
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />o9114111a1x01 5
<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 0048 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(les) 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 endorsements).
<br />PRODUCER
<br />Fullerton Insurance Sarv"
<br />CONTACT
<br />NAME: t:ommeYClai Linea DaIS -
<br />CDI110596796
<br />CDI0x
<br />atco 794-ST7.5800 I tate Nor, 794.447.00'11
<br />4054
<br />Fullerton, CA 92834.4054
<br />E -Man
<br />ADOA88; rec fullertonlnsurance.com
<br />._........__...
<br />INSURER1a7AFFarwrm ccvERACE
<br />NAiCN
<br />Leslie A. McCarthy, CIC
<br />GENT. AGGREGATE LIMIT APPLIES PER:
<br />INSURER A, Non rofltelns,AllianceofCA
<br />GENFRALAGGREGATE $ 2,000,0110
<br />INSURED Women's Transitional Living
<br />INSURER 3: New York Marine & General Ins.
<br />16608
<br />Center Inn.
<br />INSURER C ;
<br />PRODUCTS - COMPIOP AGG $ 2,000,000
<br />P.O, Box 916
<br />Fullerton, CA 92832
<br />INSURER D
<br />AUTOMOBILELIARILRY
<br />_INSURER E.
<br />A X ANY AUTO
<br />201601835NPO 09101/2015
<br />INSURER F,
<br />ALL OS
<br />UTOSSCHEDLEO
<br />UTOS
<br />COVERAGES CERTIFICATE NUMBER: RrviAlow NUMRFa•
<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 />IYSRL,A' TYPEOFINSURANCFWOL
<br />POLICYNUMBER
<br />Community Development Agency
<br />N X COMMERCIAL GENERAL LIABILITY
<br />Daniel Perez
<br />EACH OCCURRENCE $ 1.000,00
<br />CLAUJS MADE %t OCCUR
<br />x 01501885NPO 0970172015
<br />0910112010 DAM T -..-.....-.
<br />FREMIaEE Ea «xrir $ 500,00
<br />....
<br />MEO E%P AnYana person) $ 20,00
<br />PERSONAL&ADVINJURY $ 1,000,000
<br />GENT. AGGREGATE LIMIT APPLIES PER:
<br />GENFRALAGGREGATE $ 2,000,0110
<br />x
<br />El
<br />.................
<br />POLICYjCOT LOC
<br />PRODUCTS - COMPIOP AGG $ 2,000,000
<br />OTHERS:
<br />$
<br />AUTOMOBILELIARILRY
<br />CEOMBINSINGI.E LIMIT
<br />a a cltl F..D$ 11000,000
<br />A X ANY AUTO
<br />201601835NPO 09101/2015
<br />09101/2016 BODILY INJURY (Per Person) $ .................
<br />ALL OS
<br />UTOSSCHEDLEO
<br />UTOS
<br />BODILY INJURY Per accident) $
<br />(
<br />NON -OWNED
<br />x 411RE0 AUTOS AUTOS
<br />--- HIRED
<br />41000coll
<br />_
<br />PROPERTY DAMA E
<br />Per accitlenl
<br />$500 Comp
<br />x UMBRELLA LIAR x OCCUR
<br />EACH OCCURRENCE 1§ 5,000,00
<br />A ExDEss UAB CLaIMSMADF
<br />0150183SUMBNPO 09101[12015
<br />0910112016 AGGREGATE -$ 51000,04
<br />DOE) I RETENTION$
<br />g
<br />WORKERS COMPENSATIONPER
<br />X CRH
<br />AND EMPLOYERS' LIABILITY YIN
<br />STATUTE R
<br />B ANY PROPRIETORWARTNERJEXECU7VE
<br />WC201500005441 03!20/2015
<br />MIA
<br />03/2012016 E.L. EACH ACCIDENT 1,000,00
<br />OPFICERMEINBER EXCLUDED?
<br />(Mandatory In NH)
<br />...--_----...—._ .. ... ....................._,__._,_.�
<br />EL. DISEASE - EA EMPLOYE '$ 11000,000
<br />SIaIIP OPTON OFOPERRTIONS b010W
<br />E.L. DISEASE -POLICY LIMIT $ _— 11000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD101,Additional RamarkaSchedule,maybealtaairedif,m,roepo oIsrequlred)
<br />City of Santa Ana, its c££ieers, ageata employees and volunteers are named
<br />as additional inouseds as respeote to theggeneral liability policy limits
<br />andorsoment CO2C12 to the
<br />per attached poli.oy with coverage primary and
<br />XXACE61
<br />non-contributory per endorsement attached to the pol ey.
<br />d �W, 77'r
<br />" V
<br />CERTIFICATE HOLDER CANCFI_I ATION
<br />CISANBE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana-ESG M-25
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Daniel Perez
<br />--
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 1980 M-25
<br />Santa Ana, CA 92702
<br />©1988-2014 ACORD CORPORATION. All rights ressrvod.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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