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CHAMGRO-01
<br />RENAS
<br />�►co�ro„ CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />5/10/2024
<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 # OM10410
<br />Armstrong/Robitaille/Riegle Business and Insurance Solutions Dig
<br />1500 Quail St, Suite #100
<br />Newport BeachlkCA 92660 Ace
<br />Angie Acevedo Dat
<br />CONT CT
<br />A c, N , Ex ).
<br />- 0 FAX No>:(949) 861-9429
<br />E-MAI arrinfo@aleragroup.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />.:S �4a &J, 4c t312ny
<br />17370
<br />INSURED t
<br />-07'=
<br />ERB: KeyRisk Insurance Company
<br />10885
<br />RERC: Insurance Co of the West
<br />27847
<br />Chambers Group Inc.
<br />INSURER D :
<br />3151 Airway Ave, Suite F208
<br />Costa Mesa, CA 92626
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER- 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />X
<br />X
<br />ECP2026303-16
<br />5/12/2024
<br />5/12/2025
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />100 000
<br />$
<br />MED EXP (Any oneperson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY X JECT El LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 1,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Perperson)
<br />$
<br />ANY AUTO
<br />BAP2037737-12
<br />5/12/2024
<br />5/12/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />FFX2026322-16
<br />5/12/2024
<br />5/12/2025
<br />AGGREGATE
<br />$ 10,000,000
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />WSD505523304
<br />5/12/2024
<br />5/12/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N/A
<br />E.L. DISEASE- EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />$
<br />A
<br />Pollution Liability
<br />ECP2026303-16
<br />5/12/2024
<br />5/12/2025
<br />Limit
<br />1,000,000
<br />A
<br />Professional Liab.
<br />ECP2026303-16
<br />5/12/2024
<br />5/12/2025
<br />Limit
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as additional insured per the attached form. Waiver of Subrogation applies to the
<br />General Liability policy per the attached form. Primary/Non-Contributory wording applies to the General Liability policy per the attached form. 30 Day Notice
<br />of Cancellation with the exception of 10 days for non-payment of premium.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREO
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PRC RiskMougmumtDMslcrn
<br />Risk Management Division E
<br />20 Civic Center Plaza f REVIEWED & APPROVED BY.
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVEx,
<br />✓'�^" ""1' Risk Management Specialist
<br />ACORD 25 (2016/03) © 1988-2015 ACORD
<br />The ACORD name and logo are registered marks of ACORD
<br />
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