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<br />Ally CERTIFICATE O LIABILITY INSUF! A tasty03/04/2022 Y)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM L ND NO RIGHI t T TE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE A D, E LTER THE , TVE GE AFFORDED BY THE POLICIES
<br />JV
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ONTRACT BETWE' N Ace
<br />AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. �VUU �VJ
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INS D, [gyp pgggjjj{{{���yyy{{{LLLes) yyyggg[[[be r 1r�-Sb.'RROGATION IS WAIVED subject to
<br />the terms and conditions of the policy, certain policies may r �i t,n! .� /e 3 m t on 'Da te doe�022er n its 116
<br />certificate holder in lieu of such endorsement(s). C C " .J v
<br />Dufour Insurance Services, LLC
<br />5611 Littler Drive
<br />Huntington Beach, CA 92649
<br />Stephanie Dufour
<br />INSURED Latino Center for Pre,
<br />and Action, dba
<br />Latino Health Access
<br />450 W. Fourth Street
<br />Santa Ana, CA 92701
<br />PHONI IAIC.N=Ea,,.7 '4-?J9-2998 I U.-tu� (TC.iNol U/ %JU
<br />9411111TIq:&Tr.1 919KAI=1!11I171[.1=: :1A9691GRIII:�
<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 />rypE OFINSURANCE
<br />ADDL
<br />SUBft
<br />pOLICYNUMBER
<br />POLICYEFF
<br />POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />PREMISES E.....nonce
<br />$ 500,00
<br />A
<br />X COMMERCWLGENERALLIABILITY
<br />CLAIMS -MADE Fx] OCCUR
<br />X
<br />X
<br />2021-04261-NPO
<br />07/05/2021
<br />07/06/2022
<br />MED EXP (Any one person)
<br />$ 20,00
<br />PERSONAL a ADV INJURY
<br />$ 1,000,00
<br />A
<br />X Professional
<br />2021-04261- NPO
<br />0710612021
<br />07/05/2022
<br />X
<br />Abuse
<br />GENERALAGGREGATE
<br />$ 3,000,00
<br />A
<br />2021.04261- NPO
<br />07/06/2021
<br />07/05/2022
<br />GEN'LAGGREGATE
<br />LIMITAPPLIES
<br />PER:
<br />PRODUCTS-COMP/OP AGG
<br />$ 3,000,00
<br />POucr
<br />PRO- X
<br />Loc
<br />Deductibl
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,00
<br />BODILY INJURY (Par person)
<br />$
<br />A
<br />X
<br />ANY AUTO
<br />2021-04261-NPO
<br />07/05/2021
<br />07/0512022
<br />ALLOWNED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />PER ACCIDEN
<br />$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />Deductible
<br />$
<br />J(
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />AGGREGATE
<br />$ 5,000,00
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />2021-04261-UMB-NPO
<br />07/05/2021
<br />07/06/2022
<br />DED I X I RETENTION $ 10,000
<br />$
<br />6
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />SWC1374729
<br />01/0112022
<br />01/01/2023
<br />X WC STALIMTU- OTH-
<br />E.L. EACH ACCIDENT
<br />$ 1;000,00
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,00
<br />If yes, descnbe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,00
<br />O
<br />Cyber Liability
<br />PHSD1684193
<br />12/12/2021
<br />12/12/2022
<br />Per Occ 1,000,00
<br />A
<br />Liquor Liability
<br />2021-04261- NPO
<br />07/05/2021
<br />07/06/2022
<br />Aggregate 3,000,00
<br />DESCRIPTION OFOPERATIONS/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 />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 />AUTHORIZEDREPRESENTATIVE 1
<br />{ r'7LGlL
<br />© 1988-2010 ACOR
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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<br />Risk Management Speoalist00
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