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CERTIFICATE OF LIABI (C DATE (MMODNYYY) D 7/27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND FtONFERS NO RIG TY AMEND, EXT�reSf-��U�L7f,pE HOLDER. THIS ES BELOW, THIS CERTIFICATE ATE DOES NOT FOF INSURANCE DOES VELY OR ANOTLCONST CONSTITUTE A= IR"fHS�� 7 1 @RB(S),TAUTHORIZHE ED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riahts to the certificate holder in lieu of such endorsementlsl. PRODUCER Bolton Insurance Services LLC 3475 E. Foothill Boulevard Suite 100 Pasadena CA 91107 INSURED Community SeniorSew Inc dba Meals on Wheels 1200 North Knollwood Circle Anaheim CA 92801 CUVERACdE5 CERI IFICAIE NUMBER: 900458423 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POUCYNUMBER POLICY BEE POLICY UP LIMITS A COMMERCIAL GENERAL LIABILITY Y Y PHPK2434485 7/1/2022 7/1/2023 EACH OCCURRENCE $1.000,000 CLAIMS-MADErx] OCCUR DAMAGETORENTED PREMISES Ea occurrence $1,000,000 MED UP Any ape person) $ 20,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $3,000,000 X POLICY ❑JECT LOC PRODUCTS - COMP/OP AGO $3,000,000 $ OTHER: A AUTOMOBILE LIABILITY PHPK2434485 7/1/2022 7/1/2023 EOMOIINdEeDtSINGLE LIMIT $1,000,000 BODILY INJURY(Per person) $ OWNED SCHEDULEDBODILY AUTOS ONLY AUTOSHIRED RANYAUTO INJURY (Per accident) § X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE$ Per accident A X UMBRELLALIAS OCCUR PHUBS22109 7/1/2022 7/1/2023 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 EXCESS LIAB CLAIMS�dADE DED X RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y COWC353257 7/l/2022 7/1/2023 X I STATUTE ERA E.L. EACH ACCIDENT I $1,000,000 ANYPROPRIETOMPARTNEWEXECUTIVE OFFICERIMEMBEREXCLUDEDy El NIA E.L. DISEASE -EA EMPLOYEE[$1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $t,a00,000 A Professional Lability PHPK2434485 7/1/2022 7/1/2023 Each lndderd $1,000,000 A C Abuse/Molesation Cyber Liability PHPK2434485 ESL0039484501 7/1/2022 7/1/2022 7/1/2023 7/1/2023 Aggregate Limit Aggregate Lmlt $1,000,000 $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLE& (ACORD 101, Additional Remares Schetlule, may be a0achetl H more space is required) GL AI & WOS applies per PIGLDHS1011 attached, only if written by contractlagreement. GL PNC applies per PIGL0050712 attached. WC Waiver of Subrogation applies per WC99041 OC attached. Additional Insured(s): City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (M-30) PO Box 1988 AUTHORIZEDREPRESENTATIVE Santa Ana CA 92702 Ir �t �✓ EwED&gnwdIXDIfEWEY/Ep & APPROVED Sr.BY: ©1988-2015 ACORD °� i, g A-JU Aav4ia ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ®' Rise Management spedxist