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A n q I e Digitally siOA-Tg4_1 OP ID: CA1
<br />ACC7R0 gle DATE(MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY TSUR A,adQ 106/28/2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE JP(E)b ffHE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CJVFP,,,y� QRDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRA TWEE'a THE SURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ' 20:14:18-07'00'
<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 NAME: CONTACT Stephanie Dufour
<br />Dufour Insurance Services, LLC PHONE 714-369-2998 aIc No
<br />6611 Littler Drive vc No Ext
<br />Huntington Beach, CA 92649 or nQIF... Steohanie0clufourinsurance.com
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: Nonprofit Insurance 524210
<br />INSURED Latino Center for Prevention INSURER B:Security National Ins-AmTrust
<br />and Action, dba INSURER c: Philadelphia Indemnity 18058
<br />Latino Health Access
<br />450 W. Fourth Street INSURER D 7
<br />Santa Ana, CA 92701 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 />WVDSUB
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM DD YYYY
<br />POLICY EXP
<br />MM /DD YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />2022-04261- NPO
<br />07/06/2022
<br />07/06/2023
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 500 t)t)t)
<br />CLAIMS -MADE � OCCUR
<br />MED EXP (Anyone person)
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />A
<br />X Professional
<br />2022-04261- NPO
<br />07/06/2022
<br />07/06/2023
<br />X
<br />Abuse
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />A
<br />2022-04261- NPO
<br />07/06/2022
<br />07/06/2023
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />POLICY PRO X LOC
<br />JECT
<br />Deductibl
<br />$ 0
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1000000
<br />$ e e
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />X ANY AUTO
<br />2022-04261- NPO
<br />07/06/2022
<br />07/06/2023
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />PER ACCIDENT)
<br />$
<br />Deductible
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />2022-04261-UMB-NPO
<br />07/06/2022
<br />07/06/2023
<br />DED X RETENTION $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N / A
<br />SWC1374729
<br />01/01/2022
<br />01/01/2023
<br />X WCSTATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Cyber Liability
<br />PHSD1684193
<br />12/12/2021
<br />12/12/2022
<br />Per Occ 1,000,000
<br />A
<br />Liquor Liability
<br />2022-04261- NPO
<br />07/06/2022
<br />07/06/2023
<br />Aggregate 3,000,000
<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, 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 />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />y ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ARPA funded food distribution
<br />Contractor AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 y�(a t w, w.,.��e"„�� rn Risk Dns
<br />ian
<br />REVIEWED & APPROVED BY:
<br />© 1988-2010 ACORD CO e Aezvaa
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD — Risk Management specialist
<br />
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