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Francine R. Villarpa Digitally signed by Francine R. Villareal <br />-ry 21.03.2206:4(uWfiy: SD <br />AIll 0. CERTIFICATE OF LIABILITY INSURANCE <br />DATE/2312021 <br />02/2312021 <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 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 Oeu of such endorsement(s). <br />PRODUCER <br />Dufour Insurance Services, LLC <br />5611 Littler Drive <br />Huntington Beach, CA 92649 <br />CONTACT <br />NAME: Stephanie Dufour <br />gIC,N E 1,714-369-2998 AIC No: <br />E-MAIL P ADDRESS: Ste hanie dufourinsurance.com <br />INSURER(S) AFFORDING COVERAGE <br />NAIC 0 <br />INSURERA: Nonprofit Insurance <br />524210 <br />INSURED Latino Center for Prevention <br />and Action, dba <br />Latino Health Access <br />INSURER B: Insurance Company of the West <br />27847 <br />INSURER C <br />INSURER D: <br />450 W. Fourth Street <br />Santa Ana, CA 92701 <br />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 />DDIL <br />SUBIR <br />POLICY NUMBER <br />POLICY EFF <br />IMMIDDlrYYYYI <br />POLICY EKE <br />(MMVDDIYYYY)LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 0 OCCUR <br />X <br />X <br />2020-04261-NPO <br />0710512020 <br />07/0512021 <br />PREMISES Eaoccurrence <br />$ 500,00 <br />MED EXP(Any one person) <br />$ 20,000 <br />PERSONAL& ADV INJURY <br />$ 1,000,00 <br />A <br />X Professional <br />2020 -04261- NPO <br />07/05/2020 <br />07/0512021 <br />X <br />Abuse <br />GENERALAGGREGATE <br />$ 3,000,00 <br />A <br />2020-04261-NPO <br />0710512020 <br />07/0512021 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 3,000,00 <br />POLICY PROJECTX LOG <br />Deductibl <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />E... ident <br />1,000,00 <br />BODILY INJURY (Par person) <br />$ <br />A <br />X <br />ANY AUTO <br />X <br />X <br />2020-04261-NPO <br />07/0512020 <br />0710512021 <br />ALL OWNED X SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />PERACCIDENT <br />$ <br />Deductible <br />$ <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,00 <br />AGGREGATE <br />$ 5,000,00 <br />A <br />EXCESS LIAR <br />CIAIMS-MADE <br />X <br />X <br />2020.04261-UMB-NPO <br />07/0512020 <br />07105/2021 <br />DED I X RETENTION$ 10,000 <br />$ <br />B <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY IN <br />ANY PROPRIETOR/PARTNER/EXECUTIVEY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />WVE503936503 <br />0110112021 <br />0110112022 <br />X WC STATU- TH- <br />TORY LIMITS PER <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />E.L.DISEASE-EAEMPLOYE <br />$ 1,000,00 <br />If yes, describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,00 <br />A <br />Cyber Liability <br />X <br />X <br />2020.04261- NPO <br />07/05/2020 <br />07/0512021 <br />Per Occ 1,000,00 <br />A <br />Liquor Liability <br />X <br />X <br />2020.04261- NP0 <br />0710512020 <br />0710512021 <br />Aggregate 3,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />She City of Santa Ana, 20 Civic Center Drive, Santa Ana, CA 92701, its <br />officers, employees, agents and volunteers are named as Additional Insured <br />on this policy pursuant to written contract, agreement, or memorandum of <br />understanding. Such insurance as is afforded by this policy shall be primary <br />and any insurance carried by ity shall be excess and noncontributory, <br />The City of Santa Ana <br />Risk Management Division <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 REPRESENTATIVE <br />©1988-2010 ACORD COR <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />.r Risk MalwgalnentDiWaipn <br />a ° RRIFIAEWED&APPROVED BY. <br />fY H 44.Z. +F.4hMfifi <br />----') Risk Management Analyst <br />