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' C4C>J? '� CERTIFICATE OF LIABILITY INSURANCE FDATE(MMtDDtYYYY) 06/09/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT NAME: NATIONWIDE SALES SOLUTIONS INC PHONE FAX E-MAIL INSURERS AFFORDING COVERAGE NAIC # 1200 LOCUST ST INSURER A: DEPOSITORS INSURANCE COMPANY 42587 DES MOINES _ IA 50391-9995 INSURED INSURER B : INSURER C: i INSURER D: CHAMBERS GROUP, INC INSURER E: 5 HUTTON CENTRE OR STE 750 INSURER F: SANTA ANA CA 92707-8720 COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRAOp4iSUQRT— LTR i TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMlDDIYYYY) (MMIDDIYYYYI LIMITS ' COMMERCIAL GENERAL LIABILITY F r_ CLAIMS -MADE ' OCCUR 20 Civic Plaza Santa Anna CA 92702 _ EACH OCCURRENCE I $ bAMAGE 1=O RENTED PREMISES�Eaoccurrence) ; S MED EXP (Any one person) I S PERSONAL & ADV INJURY S _ GENERAL AGGREGATE $ FGEN'L AGGREGATE LIMIT APPLIESPER: i r—I POLICY JE� i—� LOC — PRODUCTS - COMPJOPAGG S OTHER: j S LIABILITY AU ANY AUTO I i COMBINED SINGLE $ 1,000,000 i BODILY INJURY (Per person) S —' ALL OWNED r� SCHEDULED A I gUTOS ACP BAPD 2545084678 �y 1 .i AUTOS I----- NON -OWNED X I HIRED AUTOS I X h _ _..� AUTOS j 0610112015 06101/2016' BODILY INJURY (Per accident) S :— ' PROPERTY DAMAGE s lei accitlenl I S i I UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS CLAIMS -MADE � �— I AGGREGATE $ DED I RETENTION 5ILI, S ' WORKERS COMPENSATION ! i AND EMPLOYERS' LIABILITY YIN; 'ANYPROPRIETOR/PARTNERIEXECUTNEE.L. iOFFICERIMEMBEREXCLUDED't N f A; PER OTH- !STATUTE I j ER EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE, S ' (Mandatory in NH) j If yes, describe under i I DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ I I I DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 1U1, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Anna is listed as certificate holder only. Waiver of subrogation applies per form CA0444. CHAMBERS GROUP A-2013-007-02 REVIEWED BY: ffi EUNICE HEREDIA (PG 0 OF 5 CERTIFICATE HOLDER CANCELLATION ' ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Anna -Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Anna CA 92702 _ Stephanie Soppe 111 ' ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD