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<br />Francine R. Villareal vu�,tii
<br />KOS M &AS -01 0 .woad 1101M BS TE R N B E RG
<br />'`k.CERTIFICATE OF LIABILITY INSURANCE
<br />i
<br />DATE IM MIDDIYYYY)
<br />8/4/2020
<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 License # OC36891
<br />CONTACT Brett R Sternberg
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (310) 478-2625 317 (AIC, Nog
<br />Lyddy Martin Company
<br />5021 Verdugo Way
<br />Ste. 105 #414
<br />ADDRESS: brett@lyddymartin.com
<br />Camarillo, CA 93012
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA : Sentinel Insurance Company,Ltd
<br />11000
<br />INSURED Kosmont & Associates, Inc.
<br />INSURER B
<br />Dba: Kosmont Companies
<br />INSURER C:
<br />INSURER D
<br />See other named insured
<br />1601 N. Sepulveda Blvd. #382
<br />Manhattan Beach, CA 90266
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 14 REVISION NUMBER:
<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 CONTRACTOR 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
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY UP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />72SBABC3942
<br />6/27/2020
<br />6/27/2021
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />1,000,000
<br />$
<br />MED EXP (Anyoneperson)
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENU
<br />X
<br />AGGREGATE LIMITAPPLIES PER
<br />POLICY PED LOD
<br />OTHER'.
<br />GENERA -AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />AUTOS ONLY X AUTOS ONE
<br />72SBABC3942
<br />6/27/2020
<br />6/27/2021
<br />(COM BI NED S INGLE LIMIT
<br />Ea be dent)
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />(Per accRtlent AMAGE
<br />$
<br />A
<br />X
<br />UMBRELLA LAB
<br />EXCESS LAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />X
<br />X
<br />72SBABC3942
<br />6/27/2020
<br />6/27/2021
<br />EACH OCCURRENCE
<br />$ 3,000,000
<br />AGGREGATE
<br />$ 3,000,000
<br />DED X RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITV YIN
<br />ANY PROPRIETOR/PARTNER/EXECUrIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />f yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />PER OTH-
<br />STATUTE ER
<br />E. L. EACHACCIDENT
<br />$
<br />E. L. DISEASE - EA EMPLOYEE
<br />$
<br />E. L, DISEASE -POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, It's Officers, Employees, Agents, and Representatives are named Additional Insured as respects to General Liablity as per written
<br />contract. The insurance is primary and non-contributory and waiver of subrogation applies- see Business Liability Form attched
<br />Other Named Insured under the policy: Kosmont Real Estate Services
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016/03)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />REPRESENTATIVE
<br />© 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />tiaa noun.Krnu:ra, unaaa,r.
<br />Z REVIEWED & APPROVED BY:
<br />® Risk Management Analyst
<br />
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