2020/12/06 Siino, Kitty and Associates, Inc. Karen S. Siino, Kitty S. Siino001 (CONTINUED ON NEXT PAGE)
09/17/20 12/06/21
37
96
BA
SBM
SENTINEL INSURANCE COMPANY,LIMITED
ONE HARTFORD PLAZA,HARTFORD,CT 06155
A
72 SBM BA9637 SC
SIINO,KITTY &ASSOCIATES,INC
KAREN S.SIINO,KITTY S.SIINO
115 E 2ND ST STE 100
TUSTIN CA 92780
12/06/20 12/06/21 1 YEAR
LIA ADMINISTRATORS &INS SERVICES
255332
72 SBM BA9637
CORPORATION
NON-AUDITABLE
NONE
$500 MP
09/17/20
Form SS 00 02 12 06 Page
Process Date:Policy Expiration Date:
This Spectrum Policy consists of the Declarations,Coverage Forms,Common Policy Conditions and any
other Forms and Endorsements issued to be a part of the Policy.This insurance is provided by the stock
insurance company of The Hartford Insurance Group shown below.
INSURER:
COMPANY CODE:
Policy Number:
SPECTRUM POLICY DECLARATIONS
Named Insured and Mailing Address:
(No.,Street,Town,State,Zip Code)
Policy Period:From To
12:01 a.m.,Standard time at your mailing address shown above.Exception:12 noon in New Hampshire.
Name of Agent/Broker:
Code:
Previous Policy Number:
Named Insured is:
Audit Period:
Type of Property Coverage:
Insurance Provided:In return for the payment of the premium and subject to all of the terms of this policy,we
agree with you to provide insurance as stated in this policy.
____________________________________________________________________________________________________________________
TOTAL ANNUAL PREMIUM IS:
______________________________________________________________________________________________
Countersigned by
002 (CONTINUED ON NEXT PAGE)
09/17/20 12/06/21
72 SBM BA9637
001 001
115 E 2ND ST STE 100
TUSTIN CA 92780
Real Estate Appraiser
NO COVERAGE
NO COVERAGE
NO COVERAGE
NO COVERAGE
MONEY AND SECURITIES
INSIDE THE PREMISES
OUTSIDE THE PREMISES
NO COVERAGE
NO COVERAGE
Form SS 00 02 12 06 Page
Process Date:Policy Expiration Date:
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER:
Location(s),Building(s),Business of Named Insured and Schedule of Coverages for Premises as designated by
Number below.
Location:Building:
Description of Business:
Deductible:
BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE
BUILDING
BUSINESS PERSONAL PROPERTY
REPLACEMENT COST
PERSONAL PROPERTY OF OTHERS
REPLACEMENT COST
DocuSign Envelope ID: AC13251A-9D2F-4009-A0E2-FD21C9D8416B
003 (CONTINUED ON NEXT PAGE)
09/17/20 12/06/21
72 SBM BA9637
$1,000,000
$10,000
$1,000,000
$1,000,000
$2,000,000
$2,000,000
BUSINESS LIABILITY OPTIONAL
COVERAGES
CYBERFLEX COVERAGE
FORM SS 40 26
UNMANNED AIRCRAFT LIABILITY
IS EXCLUDED
SEE FORM:SS 42 06
Form SS 00 02 12 06 Page
Process Date:Policy Expiration Date:
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER:
BUSINESS LIABILITY LIMITS OF INSURANCE
LIABILITY AND MEDICAL EXPENSES
MEDICAL EXPENSES -ANY ONE PERSON
PERSONAL AND ADVERTISING INJURY
DAMAGES TO PREMISES RENTED TO YOU
ANY ONE PREMISES
AGGREGATE LIMITS
PRODUCTS-COMPLETED OPERATIONS
GENERAL AGGREGATE
DocuSign Envelope ID: AC13251A-9D2F-4009-A0E2-FD21C9D8416B
004 (CONTINUED ON NEXT PAGE)
09/17/20 12/06/21
72 SBM BA9637
LOCATION 001 BUILDING 001
TYPE PERSON ORGANIZATION
NAME SEE FORM IH 12 00
Form SS 00 02 12 06 Page
Process Date:Policy Expiration Date:
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER:
ADDITIONAL INSUREDS:THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS
LIABILITY COVERAGE IN THIS POLICY.
DocuSign Envelope ID: AC13251A-9D2F-4009-A0E2-FD21C9D8416B
005
09/17/20 12/06/21
72 SBM BA9637
SS 00 01 03 14 SS 00 05 10 08 SS 00 08 04 05 SS 00 45 12 06
SS 00 60 09 15 SS 00 64 09 16 SS 01 21 02 20 SS 42 06 03 17
SS 40 26 03 17 SS 41 63 06 11 SS 05 03 03 00 SS 05 47 09 15
SS 50 19 01 15 IH 99 40 04 09 IH 99 41 04 09 SS 83 76 01 15
SS 89 93 07 16
IH 12 00 11 85 ADDITIONAL INSURED -PERSON-ORGANIZATION
Form SS 00 02 12 06 Page
Process Date:Policy Expiration Date:
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER:
Form Numbers of Forms and Endorsements that apply:
DocuSign Envelope ID: AC13251A-9D2F-4009-A0E2-FD21C9D8416B
09/17/20 12/06/21
72 SBM BA9637
7.00
5.00
Form SS 00 45 12 06
Process Date:Policy Expiration Date:
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER:
SUPPLEMENTAL DECLARATIONS:
A service fee of $is charged for each installment when your premium is paid in
installments.The service fee is $per withdrawal when you select an elec tronic
fund transfer payment plan.The service fee will be added to the premium amount
shown on your premium billing statement.
DocuSign Envelope ID: AC13251A-9D2F-4009-A0E2-FD21C9D8416B