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76/27/2024
<br />E (MM/DDYYY)
<br />A� " CERTIFICATE OF LIABILITY INSURANCE /Y
<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 />NAME:
<br />IMA, Inc. PHONE FAX
<br />3475 E. Foothill Blvd., Suite 100 vC No Ext : 626 799-7000 A/C, No): 626 583-2117
<br />Pasadena, CA 91107 ADDRESS
<br />www.boltonco.com /\
<br />INSURED
<br />Community SeniorSery k
<br />dba Meals on Wheels
<br />1200 North Knollwood Circle
<br />Anaheim CA 92801
<br />11
<br />rT%LPRER(S)OkFIFORDINIDROVERAGE • 1 NAIC#
<br />INSURERA F'hil d i t I s r ce a 18058
<br />INSURERB ress InstrAnce Com an 10855
<br />INSURERC: Fra r C-asuRy gliLd e o of er 3 9
<br />INSURER 'a l S XC S d tu 4 1 1 eS
<br />INSURER' Of ft-f
<br />CnVFRAGFR nCFRTIFICATF NIIMRFR- Rm1FRaa ■
<br />W A ! 7 ED TO THE 1,.'_'-F7 NN:A�MED ABOVE FOR POLICY PERIOD
<br />THIS IS TO CERTIFY THAT TH O IE F N R C LItNH
<br />N O RV CrMTR T�IRLW€THE
<br />OUIR TIN
<br />SISSUEE?
<br />OLI IE R 1B HE VEI S 3ty/ t6trICH
<br />CEDRTFICATE MAYVIBE OR Y AF B TERMS,
<br />EXCLUSIONS AND CONDITIO OF S H P CIES. ITS O� N R UCED D• I • L �J V
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUM sEr
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />�/
<br />COMMERCIAL GENERAL LIABILITY
<br />/
<br />�/
<br />PHPK2573660023
<br />7/1/2024
<br />7/1/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS-MADE Iv]OCCUR
<br />A AGE To
<br />PREMIS ES (E. occurrDence)$
<br />1 ,000,000
<br />MED EXP (Any one person)
<br />$ 20,000
<br />PERSONAL & ADV INJURY
<br />$ 1 ,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$3,000,000
<br />POLICY ❑PRO JECT ❑ LOC
<br />✓
<br />PRODUCTS - COMP/OP AGG
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK2573660023
<br />7/1/2024
<br />7/1/2025
<br />(CEO, acccidentSINGLE LIMIT
<br />$ 1,000,000
<br />✓
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />�/
<br />UMBRELLA LAB
<br />�/
<br />OCCUR
<br />PHUB871395023
<br />7/1/2024
<br />7/1/2025
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />✓
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />OFFICER/MEMBER EXCLUDED? ECUTIVE ❑N
<br />N /A
<br />✓
<br />COWC562959
<br />7/1/2024
<br />7/1/2025
<br />�/ STATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1 000 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1 ,000,000
<br />A
<br />Professional Liab.
<br />PHPK2573660023
<br />7/1/2024
<br />7/1/2025
<br />3,000,000 Aggregate
<br />A
<br />Abuse/Molestation
<br />PHPK2573660023
<br />7/1/2024
<br />7/1/2025
<br />2,000,000 Aggregate
<br />C
<br />Employee Dishonesty
<br />10868258
<br />7/1/2024
<br />7/1/2025
<br />1,000,000Aggregate
<br />D
<br />C ber Liability
<br />CYB10807086500
<br />7/1/2024
<br />7/1/2025
<br />5,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />GL Additional Insured & Waiver of Subrogation applies per PIGLDHS1011 attached, only if required by written contract/agreement.
<br />GL Primary & Non -Contributory applies per PIGLOO50712 attached. WC Waiver of Subrogation applies per WC990410C attached.
<br />Additional Insured(s): City of Santa Ana
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />PO Box 1988 ACCORDANCE WITH THE POLICY PRC
<br />20 Civic Center Plaza (M-30) RAMougmumtDMslcrn
<br />�
<br />Santa Ana CA 92702 % �- �`
<br />AUTHORIZED REPRESENTATIVE i � REVIEWED & APPROVEDAPPROVEDBY.
<br />! ,
<br />Ron Wanglin Risk Management Specialist
<br />© 1988-2015 ACORD
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />80715899 1 MEALONW-Cl 124-25 Master incl GRIM, CYB Nancy Cadwallader 16/27/2024 11:42:44 AM (PDT) I Page 1 of 15
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