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TRIPSMI-01 VFOSTER
<br />A�Ra CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 051/4/2018 )
<br />05/14/2018
<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 # OG19762
<br />NONTACT Victoria Foster
<br />Momentous Insurance Brokerage Inc
<br />5990 Sepulveda Blvd., #550
<br />Van Nuys, CA 91411
<br />PHONE FAX
<br />AIC, No, Ext): (818) 933-9868 arc, Nc :(818) 933-9888
<br />EMAIL . victoria.foster@mmibi.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Sentinel Insurance Company
<br />11000
<br />INSURED
<br />Tripepi Smith & Associates
<br />c/o Nicole Smith
<br />INSURERS:
<br />INSURER C :
<br />06/20/2018
<br />06/20/2019 PRS? GM TO RIS,ENTED 1,000,000
<br />PO Box 52152
<br />INSURER D :
<br />INSURER E:
<br />Irvine, CA 92619
<br />INSURER F:
<br />COVERAGES CFRTIFICATF NIIMRFR• REV!S!Om NUIkaRCR-
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />I
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />A
<br />X COMMERCIAL GENERAL LI ABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />CLAIMS -MADE OCCUR
<br />72SBAAP9446
<br />06/20/2018
<br />06/20/2019 PRS? GM TO RIS,ENTED 1,000,000
<br />X
<br />MED EXP (Any one arson 10,000
<br />PERSONAL &ADV INJURY 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE 410001000
<br />POLICY [:] PRO � LOC
<br />4,000,000
<br />PRODUCTS - COMPIOP ADS
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT 2000000
<br />_ a accident
<br />ANY AUTO
<br />72SBAAP9446
<br />06/20/2018
<br />06/20/2019 sOOILV INJURY Per arson $
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident $
<br />X
<br />AUTOS X TSON
<br />AUUO
<br />P�acctlenDAMAGE
<br />ONLY ONLY
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />72SBAAP9446
<br />06/20/2018
<br />06/20/2019 1,000,000
<br />AGGREGATE
<br />DED XI RETENTION$ 10,000
<br />A
<br />WORKERS COMPENSATION
<br />V( PER OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />ISTATUT ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />72WECGF7491
<br />06/20/2018
<br />06/20/2019 E.L EACH ACCIDENT 1,000,000
<br />CER/Mq
<br />(Mandatory in ER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />11000,000
<br />E.L. DISEASEEAEMPLOYEES
<br />DES RIPTI Nunder
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 11000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schadu Is, 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 />Lgg p
<br />LM1--UUy
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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