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TRIPSMI-01
<br />s►`�Rv CERTIFICATE OF LIABILITY INSURANCE
<br />1BELLEVUE
<br />DATE
<br />51161� Ooo19 vl 2
<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 poliey(les) 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 endomemen s).
<br />PRODUCER License # OG19762
<br />Momentous Insurance Brokerage Inc
<br />5990 Sepulveda Blvd., #550
<br />Van Nuys, CA 91411
<br />N CT Victoria Foster
<br />j�NN , E,nl: 818 933-9688, xp : 818) 933-2287
<br />et%ss. victoria.foster@jnmibl.com
<br />INSURERS) AFFORDING COVERAGE
<br />NAICN
<br />INSURER A: Sentinel Insurance Company
<br />11000
<br />INSURED
<br />Tripepi Smith & Associates
<br />Go Nicole Smith
<br />PO Box 52152
<br />Irvine, CA 92619
<br />INSURERS: Hartford Casualty Insurance Company
<br />29424
<br />INSURER C:
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />COVEZRALGEC rRRTIRIrATP NHMRRR• REVISION NUMRER:
<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 />ADDINSp
<br />SUER MOM
<br />POLICY NUMBER
<br />POLJCY EFF
<br />POLICY EXP
<br />UMRs
<br />A
<br />X
<br />COMMERCIAL GENERALLIABIUTY
<br />CLAIMS -MADE OCCUR
<br />X
<br />72SBAAP9446
<br />6120/201
<br />IV201MO
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />DAMAGES RENTED
<br />PREMISEMe occuffence)
<br />S 1,000,000
<br />MED EXP one arson
<br />S 10,000
<br />PERSONAL &ADV INJURY
<br />S 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLI ES PE R:
<br />POLICY El MET LOC
<br />OTHER:
<br />GENERALAGGREGATE
<br />4,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OPINED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />ALTOS ONLY X 00S ONLY
<br />Ix
<br />72SBAAPS446
<br />612012019
<br />_
<br />6frlt OZU
<br />COMBINED SINGLE LIMIT
<br />accident)
<br />E 2,000,000
<br />'iODILY INJURY Per
<br />$
<br />BODILY
<br />BOODILY INJURY Per acciderd
<br />S
<br />Pfge�e derieDAMAGE
<br />$
<br />E
<br />A
<br />X
<br />UMBRELLALuuS
<br />EXCESS LMB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />72SBAAP9446
<br />6/20/2019
<br />6120/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />a 11000,000
<br />DED I X I RETENTIONS 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLorERs LIABILITYYIN
<br />ANY CCPRRROPRIIETOeRRIPARTNER/EXECUTIVE
<br />1f,AandErN In NHi EXCLUDEDI
<br />If yes, dea sibe antler
<br />DESCRIPTION OF OPERATIONS below
<br />N I A
<br />72WECGF7491
<br />Gf20f2019
<br />6/20/2020
<br />X I PET 0
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />S 1,000,000
<br />E.L.DISSEASE -POUCY LIMIT
<br />S 1,000 000
<br />._a56g
<br />W
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required)
<br />Insurance in regards to the operations of the named Insured and as
<br />The City of Santa Ana, Its officers, employees, agents, volunteers and representatives are included as additional insureds under the Genera*other
<br />required by written contract, per form SS00080405 (pages 11-13 of 24) attached to the policy. The General Liability is Primary and Non-Contrer
<br />required by written contract, per form SS00080405 (page 17 of 24). The policies shall not be canceled or reduced in coverage or changed in In rial
<br />aspect without thirty (30) days prior written notice to the City, per the endorsement to be issued by the carrier.
<br />I •-•�• .... yr.;voet ulv" IY 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 5 2019 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORD:ED REPRESENTATIVE
<br />SAMAN A M. CAMBER v
<br />ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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