Laserfiche WebLink
AC----gill <br /> ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> ki.--/ 8/28/2023 <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(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> • <br /> Bolton Insurance Services L ngie <br /> HONK Q,• ' I ifftiri M CII r3 <br /> 3475 E. Foothill Boulevard E-MAa — <br /> Suite 100 E-MAILADORE.S. — <br /> Pasadena CA 91107 aksAll �1�FOP/�NG E 0 NAIL# <br /> LicenseLicense*OD08309 INSURE- Bep 1 I 1 n LC01 18058 <br /> INSURED MEALONW-C1 INSUF.R B B.cypress Insurance Company 10855Com <br /> 1200 Norttyh <br /> Knollwood <br /> Inc dba Meals on Wheels Date 2024 06 24 <br /> 1200 North Knollwood Circl INS' .2ERC: • <br /> Anaheim CA 92801 ceved 0 UREP • • <br /> REP E: 1 ,r^'J 7 ((�J <br /> •SURER F: 1 1 •2 1 •26 _l/S.0 t�LO' <br /> COVERAGES CERTIFICATE NUMBER:2073C'13 J5 ISIO IIVV MB-ttt((( <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 ADDL SUBR POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE <br /> LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y Y PHPK2573660 7/1/2023 7/1/2024 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $1,000,000 <br /> MED EXP(Any one person) 5 20,000 <br /> PERSONAL 8 ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 <br /> POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $3,000,000_ <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY PHPK2573660 7/1/2023 7/1/2024 COMBINED SINGLE LIMIT $1,000,000 <br /> (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> — OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY _ AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> _ $ <br /> A X UMBRELLA LIAB X OCCUR PHUB871395 7/1/2023 7/1/2024 EACH OCCURRENCE $10,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S 10,000,000 <br /> DED X RETENTIONS 1r1 non $ <br /> B WORKERS COMPENSATION Y COWC458088 7/1/2023 7/1/2024 PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBEREXCWDED? n N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 51,000,000 <br /> If yes.describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> A Professional Liab. PHPK2573660 7/1/2023 7/1/2024 Aggregate 3,000,000 <br /> A Abuse/Molestation PHPK2573660 7/1/2023 7/1/2024 Aggregate 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> GL Al&WOS applies per PIGLDHS1011 attached,only if written by contract/agreement. GL PNC applies per PIGL0050712 attached.WC Waiver of <br /> Subrogation applies per WC990410C attached.Additional Insured(s):City of Santa Ana <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRC\ / <br /> 20 Civic Center Plaza(M-30) Risk Management Division <br /> PO Box 1988 AUTHORIZED REPRESENTATIVE ;�� REVIEWED&APPROVED BY: <br /> Santa Ana CA 92702 A AC 4I ddo <br /> .�,+�1 <br /> '���� Risk Management Specialist <br /> ©1988-2015 ACORD / \ <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />