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DRMAU-1 0P iD: GB <br />� �e©° CERTIFICATE OF LIABILITY INSURANCE <br />kft�06/1712016 <br />FDATE cMMroDYYYY} <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 endorsement(s). <br />PRODUCER <br />Brakke Schafnitz Ins. Brokers <br />Licence #OK07568 <br />100 Wilshire Blvd. #940 <br />NAMTACT Carole S. Mitchell <br />PHONE -1357 c No : 949-313-3323 <br />E-MAILS carole.mltChell si .us <br />Santa Monica, CA e0401 <br />Daria Gray <br />INSURE 5 APFORRDING COVERAGE NAIL 0 <br />INSURER A. Westchester Surplus Lines Ins <br />'"* <br />INSURED Dr. Maureen Sassoon <br />P 0 Box 2028 <br />Palos Verdes Peninsula, CA 90274 <br />INSURER 6: <br />INSURER C: <br />EACH OCCURRENCE $ 1,000,000 <br />INSURER D <br />INSURER E <br />CLAIM5-MADE OCCUR <br />L.:---.! <br />INSURER F <br />X <br />CQ"1c Ae-E-S CERTIFICATE NUMBER: 1 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED Br=LOW 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 AFFORDFD 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 />TYPE OF INSURANCE <br />D <br />R <br />POLICY NUMBER <br />P PA <br />PO>-ICYEXP <br />MMIDO <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />'"* <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIM5-MADE OCCUR <br />L.:---.! <br />X <br />X <br />G24270427005 <br />0710112016 <br />07101!2017 <br />PREMISES(Ica occrrenne $ 50,000 <br />MED EXP (Anyone person) $ 5,00 <br />X <br />Add'I Insured <br />X <br />Prof&Pollut-CLM <br />PERSONAL &AOVINJURY $ 1,000,00 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE $ 2,000,00 <br />PRODUCTS-COMPlOPAGG $ 2,000,000 <br />X <br />POLICY PEO LRC <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />ANYAUTO <br />BODILY INJURY (Nr accident) $ <br />AAILLL,OOWNED SCHEDULED <br />AUTOS <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />� OPEdRdTYt AMAGE $ <br />a <br />UMBRELLA LIAIS <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />�CO)CCUR <br />D]EL7 RETENTIONPER <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY FROPRIETORIPARTN£RIEXECUTIVE ❑N!A <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />ITTH- <br />ST UTE ER <br />E.L. EACH ACCIDENT $ <br />EL -DISEASE -VA EMPLOYEd $ <br />E.L.DISE45E-POLICYLIMrf $ <br />Ifyas,desurl6aunder <br />DESCRIPTIO PERA7I0NS below <br />A <br />Professional Liab. <br />G24270427005 <br />07/0112016 <br />07101/2017 <br />Prof.Liab 11000,00 <br />A <br />Contractors Poli, <br />G24270427006 <br />07101/2016 <br />07/0112017 <br />Pollution 1,000,00 <br />DESCRIPTION OF OPERATIONW LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space fa raqulrad) <br />Policy Provides 30 days notice of cancellation except 10 days for nonpayment <br />Applicable Endorsements Attached where required by Written Contract mailed <br />to: SMoralesS@santa-ana.org <br />CERTIFICATE HOLDER CANCELLATION <br />CSANTAA <br />SHOULD ANY OF THE ASOVIr DESCRIBM POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Cif of Santa Ana <br />Y <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: BrIza Morales,Risk Mngr <br />P.O. Box 1988 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />'"* <br />@ 1988-2014 ACORI) CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD �� 0 <br />