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A-2021-107-02A
<br />' 0i9ud11yaenednynancWR.
<br />Francine R.Vi l l a real VNa,nl
<br />QA-1°INLT1e"'30-a1"wOP ID: SD
<br />,acoizo CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 07128/2021
<br />2812021
<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(les) 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 endorsement(s).
<br />PRODUCER
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />CONTACT Stephanie Dufour
<br />PHONE 714.369.2998 Fax
<br />A No Ex A/C No
<br />E-MAIL Ste hanie dufourinsurance.com
<br />ADDRESS; P
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC9
<br />INSURERA: Nonprofit Insurance
<br />524210
<br />INSURED Latino Center for Prevention
<br />and Action, dba
<br />Latino Health Access
<br />450 W. Fourth Street
<br />Santa Ana, CA 92701
<br />INSURER e:lnsurance Company of the West
<br />27847
<br />INSURER C:
<br />INSURER D:
<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 />LTR
<br />TYPE OF INSURANCE
<br />D
<br />POLICY NUMBER
<br />MMIODY EYYY
<br />MMIDDP XVY
<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 />X
<br />X
<br />2021.04261-NPO
<br />07105/2021
<br />07/05/2022
<br />CLAIMS -MADE OCCUR
<br />MED EXP(Any one person)
<br />$ 20,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Professional
<br />2021.04261- NPO
<br />07/0512021
<br />07/0512022
<br />X
<br />Abuse
<br />GENERAL AGGREGATE
<br />$ 3,000,00
<br />A
<br />2021.04261- NPO
<br />07/05/2021
<br />07105/2022
<br />GEN'L AGGREGATELIMIT APPLIESFER:
<br />PRODUCTS - COMPIOP AGO
<br />$ 3,000,00
<br />POLICY PRO X Loc
<br />Deductibl
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />X ANY AUTO
<br />X
<br />X
<br />2021.04261-NPO
<br />07105/2021
<br />07/05/2022
<br />ALL OWNED X SCHEDULED
<br />NON -OWNED
<br />HIREDAUTOS AUTOS
<br />BODILY INJURY(Pereccident)
<br />$
<br />PROPERTY DAMAGE
<br />PER ACCIDENT
<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 LIAB
<br />CLAIMS -MADE
<br />X
<br />X
<br />2021.04261-UMB-NPO
<br />07/0512021
<br />07/0512022
<br />DEO I X IRETENTION$ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERTLIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVEY
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH) -
<br />NIA
<br />WVE503936503
<br />01/0112021
<br />01/01/2022
<br />OTH-
<br />WCSIN
<br />X TOY S ER
<br />—NLU
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,00
<br />If he. describe under
<br />DESCRIPTION OF OPERATIONS be.
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />A
<br />Cyber Liability
<br />X
<br />X
<br />2021.04261-NPO
<br />07105/2021
<br />07/05/2022
<br />Per Occ 1,000,00
<br />A
<br />Liquor Liability
<br />X
<br />X
<br />2021-04261-NPO
<br />07/05/2021
<br />07/0512022
<br />Aggregate 3,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sc h ad old, 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 />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 COF
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />RtekManagemmtDlwslon
<br />%-ll a �. REvEWED&pAPLPRWm BY
<br />"RIslS MnnaOamentgn ltyst.=
<br />
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