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Francine R. Villar a Digitally signed by Francine RVlllareal
<br />Yd.t_i2la3.220a:a6&j&. SD
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MMIDD/YYYY)
<br />0212312021
<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(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 endorsement(s).
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />HuntingtonExt:714.3B9.299B
<br />Huntington Beach, CA 92649
<br />-
<br />CONTACT
<br />NAME: Stephanie Dufour
<br />PHONE
<br />EMAIL
<br />ADDRESS: Stephanie@dufourinsurance.com
<br />INSUI AFFORDING COVERAGE
<br />NAIC 0
<br />INSURER A: Nonprofit Insurance
<br />524210
<br />INSURED Latino Center for Prevention
<br />and Action, dba
<br />INSURERS: Insurance Company of the West
<br />27B47
<br />INSURER C
<br />Latino Health Access
<br />INSURER D:
<br />450 W. Fourth Street
<br />Santa Ana, CA 92701
<br />INSURER E:
<br />INSURER F:
<br />a�:iuytla_��a,nliraxs
<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 />IEXP
<br />LTR
<br />TYPE OF INSURANCE
<br />6R
<br />POLICY NUMBER
<br />MMIDDY EFF
<br />MMIUDY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑ OCCUR
<br />X
<br />X
<br />2020.04261-TYPO
<br />07l0512020
<br />07105/2021
<br />PREMISES Ea occurrence
<br />$ 500,00
<br />MED EXP(Any one person)
<br />$ 20,000
<br />A
<br />X Professional
<br />2020-04261- NPO
<br />0710512020
<br />07/05/2021
<br />PERSONAL B ADV INJURY
<br />$ 1,000,00
<br />X
<br />Abuse
<br />GENERAL AGGREGATE
<br />$ 3,000,00
<br />A
<br />2020.04261- NPO
<br />07/0512020
<br />07/05/2021
<br />GENT AGGREGATE
<br />POLICY
<br />LIMIT APPLIES PER:
<br />PRO-
<br />JECT X LOG
<br />PROOUCTS-COMP/OPAGG
<br />$ 3,000,00
<br />Deductibl
<br />$
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />X
<br />2020-04261-NPO
<br />07105/2020
<br />07/0512021
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />ALLOWNED SCHEDULED
<br />AUTOS X AUTOS
<br />HIREDAUTOB NON -OWNED
<br />AUTOS
<br />BODILY INJURY(Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />PER ACCIDENT
<br />$
<br />Deductible
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />X
<br />2020.04261I-UMB•NPO
<br />07/05/2020
<br />07105/2021
<br />AGGREGATE
<br />$ 5,000,00
<br />OED X RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOVERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />(MandatoOF'ICERIry In NH)BER
<br />(Mandatory in NH)
<br />N yySCRIPTIONOder
<br />NIA
<br />WVE503936503
<br />0110112021
<br />01101/2022
<br />WC STATU- OTH-
<br />X YLIMITS E
<br />E.L. EACH ACCIDEM
<br />1,000,00
<br />E.L.
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,00
<br />E.L. DISEASE POLICY LIMIT
<br />$ 1,000,00
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Cyber Liability
<br />X
<br />X
<br />2020.04261- NPO
<br />07105/2020
<br />07/05/2021
<br />Per Occ 1,000,00
<br />A
<br />Liquor Liability
<br />X
<br />X
<br />2020.04261- NPO
<br />07105/2020
<br />07/05/2021
<br />Aggregate 3,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark. Schedule, If more space is required)
<br />The City of Santa Ana, 20 Civic Center Drive, Santa Ana, CA 92701, its
<br />officers, employees, agents and volunteers are named as Additional Insured
<br />on this policy pursuant to written contract, agreement, or memorandum of
<br />understanding. Such insurance as is afforded by this policy shall be primary
<br />and any insurance carried by ity shall be excess and noncontributory.
<br />The City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 CDR
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />Lm RiskManytmtentDivIsan
<br />y REVIEWED& AP,P+ROV/ED BY.
<br />fnAtvrr,P K, 1�4CeefA4A4
<br />Risk Management Analyst
<br />
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