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Digitally signed by Francine R. <br />Francine R. Villareal Villareal <br />ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />DATE 'MMIDDIYVYV) <br />7/1/2021 <br />6/30/2020 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER LOCkton Insurance Brokers. LLC <br />CONTACT <br />NAME: <br />777 S. Figueroa Street, 52nd Pl. <br />PHONE FAX <br />Ext: AIC No: <br />CA Licunsc #OF] 5767 <br />EIC,N. <br />MAIL <br />Los Angeles CA 90017 <br />ADDRESS: <br />(2 13) 689-0065 <br />INSURERS) AFFORDING COVERAGE <br />NAICIf <br />INSURER A:Philadelphia lndemnit Insurance Co. <br />18058 <br />INSURED Community SeniorServ, Inc. <br />INSURER B: Redwood Fire and Casualty Insurance Co <br />11673 <br />INSURER C <br />1448916 Dba Meals on Wheets Orange County <br />1200 N. KnollWood Cm <br />INSURER D: <br />AnahClm CA 92801 <br />INSURER E: <br />INSURER F : <br />COVERAGES C'ONISE01 CERTIFICATE NUMBER: 15476274 REVISION NUMBER: XXXXXXX <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 rypE OF INSURANCE ADDLSUBR POLICYEFF POLICYEXP <br />LTR INSD WVD POLICY NUMBER MMIDDIYVYV MMIDDIYVYV LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />y <br />N <br />PHPK2148207 <br />7/l/2020 <br />7/12021 <br />EACH OCCURRENCE <br />$ 1,000.000 <br />CLAIMS -MADE Ix OCCUR <br />PREIM SESOEa occurr0ence <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ 20,000 <br />PERSONAL ADV INJURY <br />$ 1,000.000 <br />GEN <br />L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$ 3000000 <br />POLICY F— PROJECT- F— LOC <br />X <br />PRODUCTS-COMPIOPAGG <br />$ 3,000,000 <br />OTHER: <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />PHPK2148207 <br />7/l/2020 <br />7/1i 2021 <br />CO MB INED SINGLE LIMIT <br />Ee eooidant <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ XXXXX�i <br />ANY AUTO <br />I <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ XXXXXXX <br />HIRED NOWOWNEDPROPERTY <br />AUTOS ONLY AUTOS ONLY <br />DAMAGE <br />Per went t <br />$XXXXXXX <br />L'un1 ./Coll.Ded. <br />$ 1,000 <br />A <br />X <br />UMBRELIALIAB <br />X <br />OCCUR <br />N <br />N <br />PHUR727463 <br />7/l/2020 <br />7/1/2021 <br />EACH OCCURRENCE <br />$ 10.000.000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />$ 10,000,000 <br />DED X RETENTION $ 10,000 <br />$ XXXXXXX <br />B <br />AND EMPLOYERS' LIABILITY WORKERS COMPENSATION <br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatary in NH) <br />NIA <br />N <br />COWC141508 <br />7ll/2020 <br />7/12021 <br />PER <br />X STATUTE OIRH <br />E. L EACH ACCIDENT <br />E.L DISEASE - EA EKIPLOYEE <br />$ 1,000,000 <br />$ 1,000,000 <br />f yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I <br />I <br />EL. DISEASEPOLICYLIMIT <br />$ 1,000.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Sunta Ana, its officers, employees, agents, representafives and volunteers are all Additional Insured to the extent provided by the policy language or <br />endorsement issued or approved by The insurance carrier. Insurance provided to Additional Insured(s) is primary and non-contributory as per the allachcd <br />endw'sements orpolicy language. <br />15476274 <br />The City of Santa Ana, Risk Management <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <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 <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />Rime Mwagane rd Diuisinn <br />REVIEWED&APPROVEDBV: <br />Risk Management Analyst <br />