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CHAMB-4 OP ID: W2
<br />1.....-' CERTIFICATE OF LIABILITY INSURANCE
<br />0712DATE{MM4/2011201YY4)
<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(les) 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 endorsements ,
<br />PRODUCER
<br />Kaercher Campboll & Associates
<br />1800 Century Park East #400
<br />Los Altgeles, CA 90067
<br />Wendt Carponter
<br />r NTA T
<br />NAME.
<br />aPHONEExth (NC Noy,
<br />__
<br />E- &L'
<br />AecReSS _..
<br />INSURE,R,{S)AFFOROING COVERAGE
<br />NAtOa
<br />__ n._
<br />INSURERA:LIbertt Mutualinsurance
<br />EACH OCCURRENCE S 1,000,00
<br />INSURED Chambers Group Inc.
<br />INSURERB:Oranite State Insurance CO.
<br />X COMMERCIALGENERAt LiABILPY
<br />CtAIM6�MAOE OCCUR
<br />5 Hutton Centre Drive, Ste 750
<br />Santa Ana, CA 92707
<br />INSURER C;
<br />UVEDE104595114
<br />0614112014
<br />0610112015
<br />MED £XP{M one Lean $ 10,00
<br />INSURER 0;
<br />INSURER E ;
<br />INBURER F •
<br />y�C1
<br />Q FO
<br />I �
<br />CnVFRar:P9 CFRTIFICATB NIIMFIFR- 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 REDUCEDBY PROCLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />City of Santa Ana
<br />5URRipp
<br />POLICY NUMBER
<br />MID Y YY
<br />P
<br />tb EMP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,00
<br />PR -MB a er a $ 100,00
<br />A
<br />X COMMERCIALGENERAt LiABILPY
<br />CtAIM6�MAOE OCCUR
<br />X
<br />UVEDE104595114
<br />0614112014
<br />0610112015
<br />MED £XP{M one Lean $ 10,00
<br />PERSONALBADViNJURY $ 1,000,00
<br />X POiliutlon$lmil
<br />A avyl
<br />y�C1
<br />Q FO
<br />I �
<br />Ma
<br />X Claims Made
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AOGRE
<br />LIMIT APPLIES PER:
<br />PRODUCTS COMPIOP AGO $
<br />_2,000,00
<br />$
<br />POLIU'V
<br />PRO X LOC
<br />M•
<br />AUTOMOBILE LIABILITY„r.
<br />ANYAUT()
<br />iD�(,'prs
<br />�
<br />tT aL tta,1'
<br />MBINE” N IT
<br />BODILY INJURY (Per person) IF m
<br />BODILY INJURY (Par occident) $
<br />ALLOWNRD SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />J
<br />A„SSt9 tA$,{.t �1
<br />n ♦l
<br />PERP CC EAMAGE $
<br />It
<br />X
<br />UMERELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,00
<br />AGGREGATE $ 4;000,00
<br />A
<br />EXCESS LIAR
<br />OLAMS-MA05
<br />UMEDE104596114
<br />46101?2014
<br />0610112015
<br />DEO RETENTION$
<br />E
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS* LIABILITYOR
<br />ANY PROPRIETORIPARTNEWEXECUTIVE Y
<br />OFFICER;MEMRCR EXCLUDED?
<br />(Mantlalory In NH)
<br />NIA
<br />WCOGS257206
<br />05/1212014
<br />05/1212015
<br />X N.0 STATtY TH-
<br />L E
<br />E.L. EACH ACCIDENT $ 1,040,00
<br />E.L. DISEASE. EA EMPLOYE5 $ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />If yes, describe I ndor
<br />DESGI IPTION OF OPERATIONS below
<br />A
<br />Professional Error
<br />UVEDE104595114
<br />06/01/2014
<br />06/0112015
<br />Per Claim 2,000,00
<br />& Omissions
<br />RETRO DATE - 1/111978
<br />Aggregate 2,000,00
<br />DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (Attach ACORO 101. Additional Remarks Schedule, II mora space is rppUlmd)
<br />The Citpp of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 927011
<br />its off cars 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 />CERTIFICATE HOLDER CANCELLATION
<br />©1088-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010106) 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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />Public Works Agency M36
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Plaza
<br />Santa Ana, CA 92702l-
<br />©1088-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD
<br />
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