COMMUNITY SENIORSERV, INC. dba MEALS ON WHEELS ORANGE COUNTY (2)

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CERTIFICATE OF LIABILM06ANC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER: DATE (MMIDOn'YY^/) HOLDER. THIS THE POLICIES , AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER C i eT Bolton Insurance Services LLC '" E' PHONE 3475 E. Foothill Boulevard 626-799-7000 rAx Nn:626-Oat-3z33 Suite 100 E-MAIL '- R 95 Pasadena CA 91107 INSURED Community SeniorSery Inc dba Meals on Wheels 1200 North Knollwood Circle Anaheim CA 92801 cv NI V I� 'X.ca6cR: 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 SU R -MMPOLICY NUMBER M IUUYIYYY)n MOLICIYUP LIMITS A COMMERCIAL GENERAL LIABILITY Y Y PHPK2434485 7/1/2022 7/112023 EACH OCCURRENCE $1.000,000 A ET RE CLAIMS -MADE rX OCCUR PREMISES Ea Paunen $1.000,000 MED UP (My one person) $ 20,000 PERSONAL &AOV INJURY $1,000,000 AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $3.000,000 GEN'L X PRODUCTS-COMPIOPAGG 53.000,000 POLICY JECT 171 LOC OTHER: 3 A AUTOMOBILE LIABILITY PHPK2434485 7/1/2022 7/1/2023 COMBINED rSINGLE LIMIT $1000,000 X ANY AUTO BODILY INJURY (Per parson) S OWNED SCHEDULED BOOINJURY (Per acpdenn $ AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per scold enl S A X UMBRELLA LIAB OCCUR PHU8822109 71172022 7/112023 EACH OCCURRENCE 510.000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DEO I X I RETENTIONSin rnn $ a WORKERS COMPENSATION Y COVVC353257 711/2022 7/1/2023 X PER OTF4 AND EMPLOYERS' LIABILITY YIN BTATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPRGPRIETORIPARTNEWEXECUTIVE OFFICEWMEMBEREXCLUOEO+ NIA EL. DISEASE -EA EMPLOYE $1,000,000 (Mantlatory in NH) Ir yes, daccr a under E.L. DISEASE - POLICY LIMIT $1, 000.000 DESCRIPTION OF OPERATIONS below A A Professionalallonty AhuaelMolesalkn PHPK2434485 7/1/2022 7/1/2023 Each Incident $1.000,000 C Cyher LiahiliN PHPK2434485 7/1/2022 7/1/2023 Aggravate Camt $1.000,000 ESL0039484501 7/V2022 71112023 A99rega[e Lmut $3.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached ifmare apace Is required) GL AI & WOS applies per PIGLDHS 1011 attached, anly if written by contract/agreement. GL PNC applies per PIGLOO50712 attached. WC Waiver of Subragation applies per WC99041 TIC attached. Additional Insured(# City of Santa Ana City of Santa Ana 20 Civic Center Plaza (M-30) PO Box1988 Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e-4:" et_4C=V'.0 ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk ROMEWED & PPRoveo BY nR u4iz4Rhkbo&s 11