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Francine R. Villarpa Digitally signed by Francine R. Villareal
<br />-ry 21.03.2206:4(uWfiy: SD
<br />AIll 0. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE/2312021
<br />02/2312021
<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 Oeu of such endorsement(s).
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />CONTACT
<br />NAME: Stephanie Dufour
<br />gIC,N E 1,714-369-2998 AIC No:
<br />E-MAIL P ADDRESS: Ste hanie dufourinsurance.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC 0
<br />INSURERA: Nonprofit Insurance
<br />524210
<br />INSURED Latino Center for Prevention
<br />and Action, dba
<br />Latino Health Access
<br />INSURER B: Insurance Company of the West
<br />27847
<br />INSURER C
<br />INSURER D:
<br />450 W. Fourth Street
<br />Santa Ana, CA 92701
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />DDIL
<br />SUBIR
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMMIDDlrYYYYI
<br />POLICY EKE
<br />(MMVDDIYYYY)LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 0 OCCUR
<br />X
<br />X
<br />2020-04261-NPO
<br />0710512020
<br />07/0512021
<br />PREMISES Eaoccurrence
<br />$ 500,00
<br />MED EXP(Any one person)
<br />$ 20,000
<br />PERSONAL& ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Professional
<br />2020 -04261- NPO
<br />07/05/2020
<br />07/0512021
<br />X
<br />Abuse
<br />GENERALAGGREGATE
<br />$ 3,000,00
<br />A
<br />2020-04261-NPO
<br />0710512020
<br />07/0512021
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,00
<br />POLICY PROJECTX LOG
<br />Deductibl
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />E... ident
<br />1,000,00
<br />BODILY INJURY (Par person)
<br />$
<br />A
<br />X
<br />ANY AUTO
<br />X
<br />X
<br />2020-04261-NPO
<br />07/0512020
<br />0710512021
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />PERACCIDENT
<br />$
<br />Deductible
<br />$
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />A
<br />EXCESS LIAR
<br />CIAIMS-MADE
<br />X
<br />X
<br />2020.04261-UMB-NPO
<br />07/0512020
<br />07105/2021
<br />DED I X RETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY IN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />WVE503936503
<br />0110112021
<br />0110112022
<br />X WC STATU- TH-
<br />TORY LIMITS PER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L.DISEASE-EAEMPLOYE
<br />$ 1,000,00
<br />If yes, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />A
<br />Cyber Liability
<br />X
<br />X
<br />2020.04261- NPO
<br />07/05/2020
<br />07/0512021
<br />Per Occ 1,000,00
<br />A
<br />Liquor Liability
<br />X
<br />X
<br />2020.04261- NP0
<br />0710512020
<br />0710512021
<br />Aggregate 3,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />She 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 COR
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />.r Risk MalwgalnentDiWaipn
<br />a ° RRIFIAEWED&APPROVED BY.
<br />fY H 44.Z. +F.4hMfifi
<br />----') Risk Management Analyst
<br />
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