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© NONPROFITS <br />INSURANCE <br />ALLIANCE OF CALIFORNIA <br />A Head for Insurance. A Heart far Nonprofits, <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefornonprofits.org <br />COMMERCIAL UMBRELLA POLICY DECLARATIONS <br />PRODUCER: <br />Dufour Insurance Services, LLC <br />5611 Littler Drive <br />Huntington Beach, CA 92649 <br />Item 1 NAME OF INSURED AND MAILING ADDRESS: <br />POLICY NUMBER: 2022-04261-UMB <br />RENEWAL OF NUMBER: 2021-04261-UMB-NPO <br />Latino Center for Prevention & Action in Health & Welfare dba: Latino Health Access <br />450 West 4th St., Ste. 130 <br />Santa Ana, CA 92701 <br />Item 2 POLICY PERIOD: FROM 7/5/2022 TO 7/5/2023 <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE <br />BUSINESS DESCRIPTION: Health and nutrition education <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. <br />Item 3 THE ANNUAL AND MINIMUM PREMIUM DUE AT INCEPTION: $10,357 <br />(premium includes Terrorism Coverage - Certified Acts: $498 <br />but only for policies that indicate coverage on Schedule A - Schedule of Underlying Insurance) <br />Item 4 LIMITS OF INSURANCE: <br />a. Occurrence / Accident / Injury / Claim Limits (where applicable):...... <br />i) Each Occurrence - Commercial General Liability and Products - <br />Completed Operations Liability <br />ii) Each Accident - Business Auto Liability <br />iii) Each Injury - Liquor Liability <br />iv) Each Claim - Employee Benefits Liability <br />b. Each Claim - Directors and Officers Liability .................................... <br />C. Each Claim - Improper Sexual Conduct and Physical Abuse Liability <br />d. Each Claim - Social Service Professional Liability ............................. <br />Aggregate limits: <br />Commercial General Liability, Business Auto Liability, Products- Completed Operations <br />Liability, Liquor Liability, and Employee Benefits Liability Aggregate <br />(where applicable): ........................................................................................................... <br />Directors and Officers Liability Aggregate......................................................................... <br />Improper Sexual Conduct and Physical Abuse Liability Aggregate ................................. <br />Social Service Professional Liability Aggregate............................................................... <br />Item 5 RETROACTIVE DATES - SEE SCHEDULE OF UNDERLYING INSURANCE <br />1,000,000 <br />1,000,000 <br />5,000,000 <br />5,000,000 <br />1,000,000 <br />1,000,000 <br />5,000,000 <br />FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION (NUMBER AND EDITION DATE): <br />CU 21 30 01 15, CU 21 33 a 01 15, CU 21 33 s 01 15, IL 09 99 12 20, NIAC-EO03 UMB 08 20, NIAC-E133 UMB 05 20, NIAC-E180 UMB 01 21, NIAC-E253 UMB 08 21, <br />NIAC-E42 UMB 09 19, SCHEDULE A 01 80, UMB 231 06 16, UMB 232 06 16, UMB-100 05 21, UMB61 05 13 <br />Risk Memigment DlMsian <br />E <br />REVIEWED & APPROVED BY. <br />e Aeevaa <br />'�--'Risk Management Specialist <br />