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TRIPSMI.01
<br />LTA ;f443 11y:7
<br />III CERTIFICATE OF LIABILITY INSURANCE
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<br />DATE 0 212 7/2 0 1 8
<br />0 212 7/2 01 8
<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(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 Iteu of such endorsement(s).
<br />PRODUCER License OG19762
<br />NRAPCT Victoria Foster
<br />Momentous Insurance Brokerage Inc
<br />5990 Sepulveda Blvd., #550
<br />Van Nuys, CA 91411
<br />Alc No, E.O: (818) 933.9868 A/c, No :(818) 933-9888
<br />ADDRESS, victoria.foster@mmibi.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC k
<br />INSURERA: Sentinel Insurance Company
<br />11000
<br />EACH OCCURRENCE 2,000,000
<br />INSURED
<br />INSURER B:
<br />Tripepi Smith & Associates
<br />c/o Nicole Smith
<br />INSURER C:
<br />PO Box 52152
<br />INSURER D
<br />PERSONAL B ADV INJURY S 2,000,000
<br />INSURER E :
<br />Irvine, CA 92619
<br />INSURER F :
<br />COVERAGES CERTIFICATE_ NUMBER- RFVIRIOtd NIIMRFR-
<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
<br />TYPE OF INSURANCE
<br />ADOL
<br />INSD
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X72SBAAP9446
<br />06/20/2017
<br />06/20/2018
<br />EACH OCCURRENCE 2,000,000
<br />DAMAGE TO RENTED 1,000,000
<br />EBEMI$ES Ea .current
<br />MED EXP (Any one ers.n 10,000
<br />PERSONAL B ADV INJURY S 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECT E LOC
<br />GENERAL AGGREGATE 1 4,000,000
<br />PRODUCTS-COMPIOPAGG 4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINEDt SINGLE LIMIT $ 2,000,000
<br />BODILY INJURY Per arson $
<br />AUTO
<br />72SBAAP9446
<br />06/20/2017
<br />06/20/2018
<br />IxANY
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />SSW
<br />BODILY INJURY (Per accident
<br />Poor acclo'e t AMAGE $
<br />AUT OS ONLY X AU OSONLV
<br />A
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />72SBAAP9446
<br />06120/2017
<br />06/20/2018
<br />DED I X RETENTION$ 10,000
<br />A
<br />WORKERS COMPENSATION
<br />ANYEMPLOVERS'LIABILITY YIN
<br />OFFICEWMEMBEE EXCLUDED?ECUTIVE ❑
<br />(Mandatary In NH)
<br />NIA
<br />72WECGF7491
<br />06/20/2017
<br />06/20/2018
<br />X PTATUTE OTH-
<br />E.L. EACH ACCIDENT 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<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 />AwI
<br />CERTIFICATE HOLDER CANCELLATION-�(A.I(S
<br />ACORD 25 (2016103) @ 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />V
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<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS.CE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />C -
<br />ACORD 25 (2016103) @ 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />V
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