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<br />''`�aY� CERTIFICATE O LIABILITY INSUPI �
<br />03104/2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM L ND NO RIGHT 1 T TE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNE A D, E LTER THE . 1VE GE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ONTRACT BETWE' IN '1jI[ Ie�c,I�l1�C2 ANSLIbr(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. _ /"�L,C V ea �J
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSLj%D,
<br />the terms and conditions of the policy, certain policies may r I
<br />certificate holder In lieu of such endomement(s).
<br />Drive
<br />Services, LLC
<br />, CA 92649
<br />INSURED Latino Center for Prevention
<br />and Action, dba
<br />Latino Health Access
<br />460 W. Fourth Street
<br />Santa Ana, CA 92701
<br />tephan': Dufour
<br />7;4-7i9-2998
<br />National
<br />OUVCftAGCS GtK I IML;AIt NUMHEK: 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 />INTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUB
<br />POLICYNUMBER
<br />POLICY EFF
<br />PODCYEXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />PREMISES Ea occurrence
<br />$ 500,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />2021-04261-NPO
<br />07/05/2021
<br />07/0612022
<br />MED EXP(Anyone person)
<br />$ 20,00
<br />A
<br />X Professional
<br />2021-04261-NPO
<br />07/05/2021
<br />07/0512022
<br />PERSONAL &ADV INJURY
<br />$ 1,000,00
<br />X
<br />Abuse
<br />GENERAL AGGREGATE
<br />$ 3,000,00
<br />A
<br />2021-04261-NPO
<br />07/05/2021
<br />07/0612022
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES
<br />PER:
<br />PRODUCTS-COMP/OP AGO
<br />$ 3,000,00
<br />17 POLICY
<br />PIFCT RO X
<br />LOC
<br />Deductibi
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Eaaccident
<br />1,000,00
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />2021-04261-NPO
<br />07/05/2021
<br />07106I72
<br />ALLOWNED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />I
<br />$
<br />NON,OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />PERACCIDEN
<br />$
<br />Deductible
<br />$
<br />J(
<br />UMBRELLA OAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />2021-04261-UMB-NPO
<br />07/05/2021
<br />07/05/2022
<br />DEO I X I RETENTION $ 10 000
<br />$
<br />1
<br />B
<br />WORKERSCOMPENSATION
<br />ANDEMPLOYERS' LIABILITYIMT
<br />OFFICERIME BEER IXCLUDE07 CUTIVE Y/❑N
<br />(Mandatoryin NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />SWC1374729
<br />01/01/2022
<br />01/0112023
<br />X WC STATU- OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE EA EMPLOYE
<br />$ 1,000,00
<br />E.L. DISEASE POLICY LIMIT
<br />$ 1,000,00
<br />C
<br />Cyber Liability
<br />PHSD1684193
<br />12112/2021
<br />12/1212022
<br />Per CDC 1,000,00
<br />A
<br />Liquor Liability
<br />2021-04261- NPO
<br />07/05/2021
<br />07/0512022
<br />Aggregate 3,000,00
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS / 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 />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 />© 1988-2010 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />aot WekMuMgarladDlvWdn
<br />REvPwEC&APPRov®BY: -
<br />�' Ar.�:rAuvrda
<br />Risk Management Specialistor
<br />
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