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<br />LATINZ416a1e001.'op ID: SD
<br />1411c"R® CERTIFICATE OF LIABILITY INSURANCE
<br />DA07/28/D
<br />07/2812021 21
<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 />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />NAMEACT Stephanie Dufour
<br />A16 No E,t, 714-369.2998 FAX
<br />No:
<br />ADDRESS: Stephanie@dufourinsurance.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC0
<br />INSURER A: Nonprofit Insurance
<br />524210
<br />INSURED Latino Center for Prevention
<br />and Action, dba
<br />Latino Health Access
<br />INSURER B:Insuran Ce Company of the West
<br />27647
<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 />ADDL
<br />SUER
<br />POLICY NUMBER
<br />MMIDOY EFF
<br />MM/ODIYEYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 7 OCCUR
<br />X
<br />X
<br />2021-04261-NPO
<br />07105/2021
<br />07/0512022
<br />PREMISES Eaoccunance
<br />$ 500,00
<br />MED UP (Any one person)
<br />$ 20,000
<br />PERSONAL a ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Professional
<br />2021-04261-NPO
<br />07105/2021
<br />07/0512022
<br />X
<br />Abuse
<br />GENERALAGGREGATE
<br />$ 3,000,00
<br />A
<br />2021-04261-NPO
<br />07105/2021
<br />0710512022
<br />GENT AGGREGATE LIMIT APPLIESPER:
<br />PRODUCTS. COMPIOPAGG
<br />$ 3,000,00
<br />POLICY JECTPRO X LOC
<br />Deductibl
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />X
<br />ANY AUTO
<br />X
<br />X
<br />2021-04261-NPO
<br />07/0512021
<br />07105/2022
<br />AOX SCHEDULED
<br />AUTOS AU OS
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERT)-DAMAGE
<br />(PERACCIDENT)
<br />$
<br />Deductible
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />X
<br />2021.04261-UMB-NPO
<br />07105/2021
<br />07/0512022
<br />DID X RETENTION$ 10 000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANOEMPLOYERS'LIABILITY IN
<br />ANY PROPRIETORIPARTNERIEXECUTIVEY
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />Byes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />-
<br />WVE503936503
<br />0110112021
<br />01101/2022
<br />X WC STATU- OTH-
<br />MITS E IR
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,00
<br />A
<br />Cyber Liability
<br />X
<br />X
<br />2021-04261- NPO
<br />0710512021
<br />07105/2022
<br />Per Oce 1,000,00
<br />A
<br />Liquor Liability
<br />X
<br />X
<br />2021-04261-NPO
<br />0710512021
<br />07105/2022
<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 />The City of Santa Ana, 20 Civic Center Driver 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />�'lG-✓'-�Q� - .9e..aeo R[wEo&aAPPR vecienn
<br />REVIErxlEp iv APPROVBJ Br.
<br />@ 1988-2010 ACORD CO 1 t"'L.F„i.f,a, (Ilea
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD guk ManagemenrAnalyst
<br />
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