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Digitally signed by Francine PI <br />Francine R. Villareal-VIII=,e=I <br />f..ta(Ngp�sus:aonrgaOP ID: SD <br />,a`. o CERTIFICATE OF LIABILITY INSURANCE <br />DATEo7128/2021za/z6z1 <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 lieu of such endorsements . <br />PRODUCER <br />Dufour Insurance Services, LLC <br />5611 Littler Drive <br />Huntington Beach, CA 92649 <br />NAME CT Stephanie Dufour <br />Pnui° No Eat:714-369-2998 Ac No: <br />ADDRESS: Stephanie@dufourinsurance.com <br />INSURERS AFFORDING COVERAGE <br />NAIC N <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 />kDDL <br />R <br />POLICY NUMBER <br />MMIDDY� <br />MII IYICY YYV <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />X <br />2021-04261-NPO <br />0710512021 <br />07/0512022 <br />PREMISES Eaoccurrence <br />$ 500,00 <br />MED EXP(My one person) <br />$ 20,000 <br />PERSONAL &ADV INJURY <br />$ 1,000,00 <br />A <br />X Professional <br />2021-04261- NPO <br />0710512021 <br />07/05/2022 <br />X <br />Abuse <br />GENERALAGGREGATE <br />$ 3,000,00 <br />A <br />2021-04261- NPO <br />0710512021 <br />07105/2022 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMPIOP AGG <br />$ 3,000,00 <br />POuOY JECPRO" X LOG <br />Deductibl <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLELIMIT <br />Ea accident <br />1,000,00 <br />BODILY INJURY (Per person) <br />$ <br />A <br />X <br />ANY AUTO <br />X <br />X <br />2021-04261-NPO <br />0710512021 <br />07105/2022 <br />AOX AUTOS SCHEDULED <br />AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTYDAMAGE <br />PER ACCIDENT <br />$ <br />Deductible <br />$ <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 5,000,00 <br />AGGREGATE <br />$ 5,000,00 <br />A <br />EXCESS LIAB <br />CLAIMS -MADE <br />X <br />X <br />2021-04261-UMB-NPO <br />0710512021 <br />07105/2022 <br />DIED X RI 10,000 <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNERIEXECUTIVEYiN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />WVE503936503 <br />01/0112021 <br />0110112022 <br />X WC BIATU- OER <br />E.L. EACH ACCIDENT <br />$ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,00 <br />ff yes, cescdbe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,DO <br />A <br />Cyber Liability <br />X <br />X <br />2021.04261- NPO <br />07105/2021 <br />0710512022 <br />Per Occ 1,000,00 <br />A <br />Liquor Liability <br />X <br />X <br />2021-04261-NPO <br />07/05/2021 <br />07/05/2022 <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 />The 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE _ <br />& APP mtt>IvL <br />RtvIEwELi 4r APPROVED. <br />91988.2010 ACORD CO <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD RBk MaH.aGeD,eNCFlna <br />