|
AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DDIYYYY]
<br /> 6/20/2025
<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 CONTACT
<br /> Digital Insurance LLC-Clayton, MO PHONE Shawn Phillips FAx
<br /> 8235 Forsyth Blvd#1200 e a E •417-895-4616 .0 No);314-889-3700
<br /> Cla ton MO 63105 E-MAIL
<br /> y ADOREss: spawn . hilli s Dnedi ital.com
<br /> INSURER S AFFORDING COVERAGE NAIC#
<br /> License#:8012081 INSURER A:Hartford Underwriters Ins CO 30104
<br /> INSURED TRIPSMI-01 INSURERB:Hartford Fire Insurance Co 19682
<br /> Tripepi Smith And Associates, Inc P.Q. Box 52152 INsuRERc:Beazley Ins Co 37540
<br /> Irvine CA 92619 INSURERD:
<br /> INSURER E
<br /> _ INSURER F
<br /> COVERAGES CERTIFICATE NUMBER:436121680 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER MMIDDrYYYY MMIDDYYYY. LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y 84SBABG4S3U 6/20/2025 6/20/2026 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES Fa occurrence $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $2,000.000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $4,000.000
<br /> PRO-
<br /> POLICY JECT LOC PRODUCTS-COMPIOP AGG $4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 84S8ABG4S3U 6120/2025 6120/2026 COMB3NEn51NGLEaccident LIMIT $2404,440
<br /> Ea
<br /> ANY AUTO BODILY INJURY(Per person] $
<br /> OWNED SCHEDULED BODILY INJURY Per accident $
<br /> AUTOS ONLY AUTOS I )
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> $
<br /> A X UMBRELLA LIAB OCCUR 84SBABG4S3U 6/20/2025 6/20/2026 EACH OCCURRENCE $1,000,0o0
<br /> EXCESS LIAR Ll CLAIMS-MADE
<br /> AGGREGATE $.
<br /> DED I X I RETENTFON S $
<br /> B WORKERS COMPENSATION 84WECBG4S66 6/20/2025 6/2012026 X STATUTE �RH AND EMPLOYERS'LIABILITY YIN
<br /> ANYPROPR IETORIPARTN ERIEXECUTIVE
<br /> OFFICERIMEMBEREXCLUDED? NIA E.L.EACH ACCIDENT $1,004,OD0
<br /> (Mandatory in NH)
<br /> E.L.DISEASE-EA EMPLOYEE 51,000,400
<br /> If yes,describe under -
<br /> DESCRIPTION OF OPERATIONS below E.L.❑ISFJISE-POLICY LIMIT $1,000,000
<br /> C Cybef tech E&O Liability D226FE250801 411/2025 4I112026 PerOWA re ate gg g $2Mil1$3Mil
<br /> DED 2,5D0
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers are to be covered as additional insureds as respects to General
<br /> Liability Insurance in regards to the operations of the named insured and as required by written contract,per farm SL30320621 attached to the policy.The
<br /> General Liability is Primary and Non-Contributory where required by written contract,per form SL00001018.Waiver of Subrogation applies to the General
<br /> Liability per form SL00001018.Waiver of Subrogation applies to the Workers'Compensation,per form WC040306.
<br /> Digitally,€g"ee
<br /> Tu Tran eyr"rra"
<br /> Nguyen
<br /> Nguyen o�5'e6zb APPROVED
<br /> 12:32:48-007W Tf!Fran Nguyen at 12.31 pm,Jun 26,2025
<br /> y
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> 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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza(M-30)
<br /> P-O- BOX 1938 AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702
<br /> O 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br />
|