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CHAMB-4 OP ID: W2
<br />Afw" R®
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />TE (MM/DD/YYYY)
<br />P05/27/2015
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Kaercher Campbell &Associates
<br />1800 Century Park East #400
<br />Los Angeles, CA 90067
<br />Wendi Carpenter
<br />CONTACT ..
<br />NAME:
<br />PHONE FAX
<br />(A/C_ No, EExt D. INC, No):
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A: Liberty Mutual Insurance
<br />INSURED Chambers Group Inc.
<br />5 Hutton Centre Drive, Ste 750
<br />Santa Ana, CA 92707
<br />INSURER B: Commerce & Industry 19410
<br />INSURER C:
<br />INSURER D:
<br />EACHTE _ OCCURRENCE $ 1,000,00
<br />INSURER E:
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NI IMRFR-
<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 />SUB
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACHTE _ OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />UVEDE104595115
<br />06/01/2015
<br />06/01/2016
<br />PREMISES Ea occurrDence) $ 100,00
<br />_
<br />MED EXP (Any one person) $ 10,000
<br />X Pollution $117`111
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />X Deductibel $2,500
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGO $ 2,000,000
<br />POLICY X PRO JECT F] LOC
<br />I
<br />I
<br />Is
<br />AUTOMOBILE
<br />LIABILITYCOMBINED
<br />SINGLE LIMIT
<br />Ea accident $
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident $
<br />( )
<br />HIRED AUTOS NON -OWNED
<br />I AUTOS
<br />i
<br />PROPERTY DAMAG E
<br />I PER ACCIDENT $
<br />$ —
<br />X UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMEDE104596115
<br />06/01/2015
<br />06/01/2016
<br />AGGREGATE $ 4,000,000
<br />DED RETENTION $
<br />_
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />WC065257206
<br />05/12/2015
<br />05/12/2016
<br />X WC STATU- OTH-
<br />TORY_UIvIITS ER
<br />—
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />—
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />—
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Professional Error
<br />UVEDE104595114
<br />06/01/2015
<br />06/01/2016
<br />Per Claim 1,000,000
<br />& Omissions
<br />RETRO DATE - 1/1/1978
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701;
<br />its officers, employees, agents, volunteers and representatives are named as
<br />additional insureds ("additional insureds") with regard to liability and
<br />defense of suits arising from the operations and uses performed by or on
<br />behalf of the named insured /
<br />CHAMBERS GROUP A-2013-007-02. REVIEWED BY: ��,.- /_a EUf�JICE HEREDIA (PG 1 OF 5)
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Public Works Agency M36
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Plaza
<br />Santa Ana, CA 92702
<br />_
<br />v'
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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