SASSOON, DR. MAUREEN - 2017 - Laserfiche WebLink

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DRMAU-1 OP ID: C6 o. CERTIFICATE OF LIABILITY INSURANCE '4� OATE(M1120 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDFD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 05139!20 77 7 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 CONTACT NAME: Carole S. Mitchell Brakke Schafnitz Ins. Brokers License #OK07568 a7° .310-524-1357 A No :I49-313-3323 SantaWilshire Blvd. # 700 Sanaa Monica, CA 90401 ADDRESS: Carole. mitchell@sig.us INSURER(S) AFFORDING COVERAGE MAIC # Darla Gray INSURERA:Westchester Surplus Lines Ins urrene $ 50,000 PREMISES Ea occcc INSURED Dr. Maureen Sassoon P O BOX 2028 INSURERB: Palos Verdes Peninsula, CA 90274 INSURERC: INSURER D: PERSONAL&ADVINJURY $ 1,000,00 INSURER E: GENERAL AGGREGATE $ 2,000,00 INSURER F: L.LJVVKAL,r_, I_Fw I1FIf .-LIF NI lmmFw. 9 MR1101/ kl L111RaOCO. 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 AFFORDFD 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. !POLICY LTR TYPE OF INSURANCE IND WVD POLICY NUMBER MMIDDY EFF EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR X Add'Ilnsured X X 624270427005 07!0112017 07/01/2018 EACH OCCURRENCE $ 1,000,000. urrene $ 50,000 PREMISES Ea occcc MED EXP (Any one person) $ 5,000 X Prof & Pollut-CLM PERSONAL&ADVINJURY $ 1,000,00 GEN'LAGGREGATE LIMITAPPLIESPER X POLICY ❑ JecT ElLOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Perperson) $ ANY AUTO ALL OWNED SCHEDULEp AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE PeraccideM $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ ................. (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Professional L)ab. G24270427005 07101/2017 07/01/2018 Prof.Liab 1,000,00 A Contractors Poll. 624270427005 07/01/2017 07/01/2018 Pollution 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable Endorsements Attached are Applicable where required by Written Contract. Emailed to: SMorales5@santa-ana.org 111111161z CSANTAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Briza Morales,Risk Mngr P.O. BOX 19$$ REPRESENTATIVE= Santa Ana, CA 92702 AUTHORIZED REPRES� ©1988-2014 ACORD CORPORATION. All rig isr served. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD q P