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

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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Bolton Insurance ServiceAnaie 3475 E. Foothill Boulevar Suite 100 Pasadena CA 91107 LlCenseN: 0008309 INSURE _ : rr,l@ INSURED MEALONW-Cl INSUF =R B . 1:ypfl Community SeniorSery Inc dba Meals on Wheels 1200 North Knollwood Circl INS' .4ER C. Anaheim CA 92801 UR:R c e v e _ R URER F COVERAGES CERTIFICATE NUMBER: 2073013',5 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 lmwn SUER POLICYNUMBER POLICY EFF MM/DDIYYYY POLICY UP MM0D/YYYY LIMITS A X COMMERCIALGENERALUABILITY CLAIMS -MADE � OCCUR Y Y PHPK2573660 7/1/2023 7/1/2024 EACH OCCURRENCE $1.000.000 ET RENTED PREM PREMISES Es occurrence $1,000,000 MED EXP(My oneperson) $20,000 PERSONAL&ADV INJURY $1.000.000 AGGREGATE LIMIT APPLIES PER: POLICY D PRO- ❑ JECT LOC GENERALAGGREGATE $3.000.000 GEN1 PRODUCTS-COMP/OP AGG $3,000,000 $ OTHER: A AUTOMOBILE LIABILITY PHPK2573660 7/1/2023 7/1/2024 COMBINED SINGLE LIMIT Ea accident) $1,D00,000 X BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURYJr.,accident ( i $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY[DAMAGE Per accident $ $ A X UMBRELLA LIAB N OCCUR PHUBS71395 7/1/2023 7/1/2024 EACH OCCURRENCE $10,000,000 AGGREGATE $10.000,000 EXCESSLIAB CLAIMS -MADE DED X RETENTION$ in Drop $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y COWC458Da8 7/1/2023 7/1/2024 SEATUTE ERH E.L. EACH ACCIDENT $1.000,000 ANYPROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ 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 $1,000,000 A A Professional Uab. Abuse/Molestation PHPK2573660 PHPK2573660 7/1/2023 7/1/2023 7/1/2024 7/1/2024 Aggregate Aggregate 3.000.000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) GL AI & WOS applies per PIGLDHS1011 attached, only if written by contract/agreement. GL PNC applies per PIGLOO50712 attached. WC Waiver of Subrogation applies per WC990410C attached. Additional Insured(s): City of Santa Ana City of Santa Ana 20 Civic Center Plaza (M-30) PO Box 1988 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 PRC RideMnngemmtDlaWlon �� REVIEWED6APPRWEDBY: ® Risk Management SpeaAnt �> ©1988.2015 ACORD ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD