|
__01411i TRIPSMI-01
<br />VFOSTER
<br />DATE(412020 MMIDDYYYY)
<br />,4`oRo CERTIFICATE OF LIABILITY INSURANCE
<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 endorsements .
<br />PRODUCER License#OH18131
<br />g2jjACT Victoria Foster
<br />Momentous Insurance Brokerage, A Marsh & McLennan Agency LLCN
<br />Company
<br />5990 Sepulveda Blvd., #550
<br />o. Ext: 818 933-9868 ,Np: 818 933-2287
<br />E I . victoria.foster@mmibi.com
<br />INSURERS AFFORDING COVERAGE
<br />NAI
<br />Van Nuys, CA 91411
<br />INSURER A Sentinel Insurance Company
<br />11000
<br />INSURED
<br />IN RER B : Hartford Steam Boller Inspection and Insurance CO.
<br />11452
<br />IN SURER C
<br />Tripepi Smith & Associates
<br />c/o Nicole Smith
<br />PO Box 52152
<br />INSURER E
<br />Irvine, CA 92619
<br />INSURER F :
<br />COVERAGES CFRTIFICATF NIIMRFR- 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 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 LTRTYPE
<br />OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />[COMMERCIAL GENERAL LIA&IJTY
<br />CLAIMS -MADE �OCCU
<br />X
<br />2SBAAP9446
<br />6/2012020
<br />612012021
<br />EACH OCCURRENCE
<br />2,000,000
<br />DAMAGE TO RENTED
<br />1,OOQ000
<br />MEDEXP An one ersm
<br />10,000
<br />s/
<br />VI-1,
<br />PERSONAL &ADV INJURY
<br />S 2,000,000
<br />GENL AGGREGATE LIRM�B APPLIES PER:
<br />POLICY �X dECT LOC
<br />GENERAL AGGREGATE
<br />4,000,000
<br />PRODUCTS -COMP/OPAGG
<br />S 4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />in
<br />2,000,000
<br />BODILY INJURY Per person)
<br />ANY AUTO
<br />2SBAAP9446
<br />6/2012020
<br />6120/2021
<br />BODILY INJURY Per accident
<br />AUTEO�S ONLY A,��WWWLNNEEEDpp
<br />�
<br />./
<br />X
<br />PPaOa EttiGent AMAGE
<br />AUTOS ONLY X AUTNOONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />11000,000
<br />A
<br />1,000,000
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />72SBAAP9446
<br />6120/2020
<br />612012021
<br />DED X RETENTIONS 10,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERT LIABILITY y IN
<br />PROPRIETORIPARTNEFVEXECUTIVE
<br />W.F.gryMggREXCLUDED?
<br />s ,tlescrioe antler
<br />D R191 N F P
<br />NIA
<br />2WECGF7491
<br />612012020
<br />612012021
<br />PER OTH-
<br />EACH HA ACCIDENT
<br />0
<br />00ANY
<br />100'0g00iO
<br />EA EMPLOYEE
<br />E.L. I - POLICY
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is recut red)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds under the General Liability
<br />Insurance in regards to the operations of the named Insured and as
<br />required by written contract, per form SS00080405 (pages 11-13 of 24) attached to the policy. The General Liability is Primary and Non -Contributory where
<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 any other material
<br />aspect without thirty (30) days prior written notice to the City, per the endorsement to be Issued by the carrier.
<br />REVIEWED & APP
<br />BEFORE
<br />tuVV , 2020 THEULD EXANYPIRATTIIONH DATTEy THEREOFDESCRIBE NOTICEEWILL CBEC ELLED DELIVERED IN
<br />City of Santa Ana - ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 ANCIIE ACEVEdO AUTHORIZED REPRESENTATIVE
<br />M
<br />rim
<br />ACORD 25 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|