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LATIN-1 OP ID: CA1
<br />Ate./ p® CERTIFICATE OF LIABILITY INSURANCE OA03/04/04/2022 V)
<br />022
<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 INSURERS), 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 endorsements .
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />6611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />NONEACT Stephanie Dufour
<br />acNo •714-369-2998 Plc No:
<br />poD2ess: Stephanie@dufourinsurance.com dufourinsurance.com
<br />INSURER(S)gFFORDING COVERAGE
<br />NAICN
<br />INSURER A: Nonprofit Insurance
<br />524210
<br />_
<br />INSURED Latino Center for Prevention
<br />and Action,
<br />Latino Healthh Access A
<br />INSURER 13:Security National Ills-AmTrust
<br />INSURER C:Philadel hia Indemnity18068
<br />INSURER D:
<br />460 W. Fourth Street
<br />INSURER E:
<br />Santa Ana, CA 92701
<br />INSURER F :
<br />COVEKAGES CERTIFICATE NUMBER: REVISION NIIMRER-
<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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRR
<br />TYPE OF INSURANCE
<br />Ao oLsUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />DDqyYYY1
<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 />2021-04261-NPO
<br />07/06/2021
<br />07/06/2022
<br />PREMISES Ea occurrence
<br />_
<br />$ 500,00
<br />MED EXP(Any one person)
<br />$ 20,000
<br />A
<br />X Professional
<br />202144261- NPO
<br />07/06/2021
<br />07/06/2022
<br />PERSONAL a ADV INJURY
<br />$ 1,000,00
<br />X
<br />Abuse
<br />GENERAL AGGREGATE
<br />$ 3,000,00
<br />A
<br />2021.04261-NPO
<br />07/06/2021
<br />07/0512022
<br />GERL AGGREGATE
<br />LIMITAPPLIES
<br />PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,00
<br />PRO X
<br />LOC
<br />Deductibl
<br />$POLICY
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />11000,00
<br />BODILY INJURY (Per parson)
<br />$
<br />A
<br />X
<br />ANY AUTO
<br />2021.04261-NPO
<br />07105/2021
<br />07/06/2022
<br />AUTOS ALLOWNED X SCHEDULED
<br />AUTO
<br />BODILY INJURY (Per scalded)
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />OPERTY
<br />PRDAMAGE
<br />PER ACCIDENT
<br />$
<br />Deductible
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />Is 5,000,00
<br />A
<br />EXCESSUAB
<br />CLAIMS -MADE
<br />2021-04261-UMB-NPO
<br />07/0512021
<br />07/06/2022
<br />DED X RETENTION $ 10,000
<br />§
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYEFL
<br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />SWC1374729
<br />01/0112022
<br />01/01/2023
<br />X TORV TATUS OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,00
<br />(Mandatory In kin
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />EL.DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />C
<br />Cyber Liability
<br />PHSD1684193
<br />12/1212021
<br />12/12/2022
<br />Per Occ 1,000,00
<br />A
<br />Liquor Liability
<br />2021.04261-NPO
<br />07/06/2021
<br />07105/2022
<br />Aggregate 3,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD tot, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, its officers, officials, employees,& volunteers are
<br />to be covered as additional insureds & Waiver of Subro on the CGL respect to
<br />liability arising out of work or operations performed by or on behalf of the
<br />Contractor including materials, parts, or equipment furnished in connection
<br />with such work or operations Insurance is Primary ad NonContributory
<br />City of Santa Ana
<br />ARPA funded food distribution
<br />Contractor
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05)
<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 />© 1958-2010 ACORD CO
<br />The ACORD name and logo are registered marks of ACORD
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