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HomeMy WebLinkAboutCHAMBERS GROUP, INC. 2BC 2CFJ� City of Santa Ana Clerk of the Council COTC Office Use Only ------------------------ - - ---- -- --- - ................. . . . .. . .................... ........ AGREEMENT TERMINATION FORM ni-A Please complete this form when the attached agreement and all Q �k N amendments (if any) are no longer in effect. ciTY Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. /I —�/3 (List all amendments. Revised 10.31-12 zcompleted on Use space below if needed.) /,z - 3 /- 13 and final payment has been made. Department: t 41 Phone/Ext.: v Signature: Date: MAYOR Miguel A. Pulido MAYOR PRO TEM Sal Tinaiero COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincent F. Sarmlento CITY 4F SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza M-36 s P.O. Box 1988 M-36 Santa Ana, California 92702 wwW.santa-ana.ora Chambers Group, Inc. 5 Hutton Center Drive, Suite #750 Santa Ana, California 92707 Re: Environmental Consultant Services Agreement A-2013-007 A-2013-007-02 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar Pursuant to the Consultant Agreement you entered with the City of Santa Ana on January 7, 2013, Section 5 — "Term the time period of the agreement is hereby extended from December 31, 2014 until December 31, 2015. The insurance certificates and Additional Insured Endorsement are required to be extended and/or renewed to cover this extension. All other terms and conditions of the original agreement remain unchanged and In full force and effect. If you have any questions in this regard, please feel free to contact my office at 714- 647-5662 Sincerely, reMousavlpour Jos4h Staka xe utive Director Assistant City Attorney Public Works Agency ATTEST, MA�DHIZAR CLERK OF THE CCNU IL SANTA ANA CITY COUNCIL Miguel A. Pulido $$I Tnajero j Vincent F. Sarmiento Michele Martinez I Angelica Amozcua P. nadd aenavides j Roman Reyna Mayor I Mayor Pro Tem, Ward 6 1 Wartl t Ward 2 i Wartl 3 I Ward 4 Ward 5 MPulidoLa',, Oaenovdes(rJ rd*,ao� i ftRevnan,apla a_ n» CHAMB-4 OP ID: W2 1.....-' CERTIFICATE OF LIABILITY INSURANCE 0712DATE{MM4/2011201YY4) 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsements , PRODUCER Kaercher Campboll & Associates 1800 Century Park East #400 Los Altgeles, CA 90067 Wendt Carponter r NTA T NAME. aPHONEExth (NC Noy, __ E- &L' AecReSS _.. INSURE,R,{S)AFFOROING COVERAGE NAtOa __ n._ INSURERA:LIbertt Mutualinsurance EACH OCCURRENCE S 1,000,00 INSURED Chambers Group Inc. INSURERB:Oranite State Insurance CO. X COMMERCIALGENERAt LiABILPY CtAIM6�MAOE OCCUR 5 Hutton Centre Drive, Ste 750 Santa Ana, CA 92707 INSURER C; UVEDE104595114 0614112014 0610112015 MED £XP{M one Lean $ 10,00 INSURER 0; INSURER E ; INBURER F • y�C1 Q FO I � CnVFRar:P9 CFRTIFICATB NIIMFIFR- REVISION NUMBER: 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 REDUCEDBY PROCLAIMS. INSR TYPE OF INSURANCE City of Santa Ana 5URRipp POLICY NUMBER MID Y YY P tb EMP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 PR -MB a er a $ 100,00 A X COMMERCIALGENERAt LiABILPY CtAIM6�MAOE OCCUR X UVEDE104595114 0614112014 0610112015 MED £XP{M one Lean $ 10,00 PERSONALBADViNJURY $ 1,000,00 X POiliutlon$lmil A avyl y�C1 Q FO I � Ma X Claims Made GENERAL AGGREGATE $ 2,000,00 GENT AOGRE LIMIT APPLIES PER: PRODUCTS COMPIOP AGO $ _2,000,00 $ POLIU'V PRO X LOC M• AUTOMOBILE LIABILITY„r. ANYAUT() iD�(,'prs � tT aL tta,1' MBINE” N IT BODILY INJURY (Per person) IF m BODILY INJURY (Par occident) $ ALLOWNRD SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS J A„SSt9 tA$,{.t �1 n ♦l PERP CC EAMAGE $ It X UMERELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4;000,00 A EXCESS LIAR OLAMS-MA05 UMEDE104596114 46101?2014 0610112015 DEO RETENTION$ E B WORKERS COMPENSATION AND EMPLOYERS* LIABILITYOR ANY PROPRIETORIPARTNEWEXECUTIVE Y OFFICER;MEMRCR EXCLUDED? (Mantlalory In NH) NIA WCOGS257206 05/1212014 05/1212015 X N.0 STATtY TH- L E E.L. EACH ACCIDENT $ 1,040,00 E.L. DISEASE. EA EMPLOYE5 $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 If yes, describe I ndor DESGI IPTION OF OPERATIONS below A Professional Error UVEDE104595114 06/01/2014 06/0112015 Per Claim 2,000,00 & Omissions RETRO DATE - 1/111978 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (Attach ACORO 101. Additional Remarks Schedule, II mora space is rppUlmd) The Citpp of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 927011 its off cars employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured CERTIFICATE HOLDER CANCELLATION ©1088-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) 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 Ana Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Ana, CA 92702l- ©1088-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: Liberty Mutual Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # UVEDE104595114 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds, 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so, included; 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 06/01/2014, this endorsement form as a part of Policy # UVEDE104595114 Issued to Chambers Group, Inc. Named Insured Countersigned by " 1— Authorized Representative CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYYI 06/04/2014 =ROOUCVEATHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY SC ASSOCIATES INC AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 2659 TOWNSOATE RD CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE WESTI.AKE VILLAGE, CA 91361 COVERAGE AFFORDED BY THE POLICIES BELOW, CHAMBERS GROUP INC 5 HUTTON CENTRE DRIVE, SUITE 750 IRVINE, CA 927078720 INSURER E: THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED 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. AGGREGATE_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INBR LTR n O'LTYPE INBR OF INSURANCE POLICY NUMBER POC EFF TIE DATE MVAR 0CI B PBEAN DATnMM)b0/YY1 LIMITS �ry INSURER, ITSAGENTS OR REPRESENTATIVES, ❑ GENERAL Y�LIABILITY COMMERICAL GENERAL LIABILITY CLAIMS MAGE OCCUR ©© ❑ ElIEP -3y EACHOCCURENOE DAMAGE TO RENTED PREMISES Ee oacurrsnca ..� $ MED EXP lAny one person) $ PERSONAL &ADV INJURY $ OENERALAGOREGATE -� $ QEMLAOGREOA7E LIMIT APPLIES PER; PRODUCT3COMP/OP AGO $ [I POLICY El PROJECT [I LOG A ® AUTOMOBILE LIABILITY ANY AUTO ACPBAPD2533084678 06/01/2014 06/0112015 COMBINED SINGLE LIMIT (ERN?Oceurrsnte) $1,090,000 ❑ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Perpereoe) a� $_ ® HIRED AUTOS ® NON -OWNED AUTOS BODILY INJURY (Pernxlden0 $ F-1 - PROPERTY DAMAGE (Paracolden4) ❑ GARAGE LIABILITY ❑ANY AUTO ❑, - - AUTO ONLY' -EA ACCIDENT $ OTHER THAN CAACC AU700NLY: AOG $ $ ❑ BXCESSIUMRELLA LIABILITY:'- El Ecom ❑ CLAIMS MADE - - EACH OCCURRENCE $ AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION S„— $ ❑ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ❑ WC $$AHTS ❑ OOTH ER _ EL. F.ACHACOIDENT $ ANY PROPRIETORIPARTNENEXECU. 'INE OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE ---------- S lfyea, describe under SPECIAL PROVISIONS below E L DISEASE, POLICY LIMIT $ -� ❑ OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSBM ENT I SPECIAL PROVISIONS ~ CERTIFICATE HOLDER IS NAMED AS AN ADDITONAL INSURED, PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES, WAIVER OF SUBROGATION IS INCLUDED, 30 DAY NOTICE OF CANCELLATION/ 10 DAY NOTICE FOR NON-PAYMENT CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001108) 0 ACORD CORPORATION 9988 8HOULDANY OFTHEABOVE OESCRIBEb POLICIES BE CANOPLLE6BEFORE THE CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVORTO 20 CIVIC PLAZA MAIL ,30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAM90 TO THE LEFT, BUT SANTA ANA, CA 92702 FAILURE TO DO 80 $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITSAGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE (C ACORD 25 (2001108) 0 ACORD CORPORATION 9988 CA 29 48 (0290) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, DESIGNATED INSURED This endorsement modifies insurance provided under the tDltawing: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement This endorsement identiffes person(s) or crganlzation(s) who are "Insureds' under the Who Is An Insured Proviolon of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Farm, SCHEDULE Name of Persons) or Organbatlon(s): CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each porson-ol ofganizatlon shown. in the'Sohadule is an 'Insured" for Liabilityy Coverage, but oni to the extent that person or organizallon qualified as an "Insured" under the Who Is An Insured Provision ocntalnad in &option 11 of the Coverage Form. Copyright, Insurance Services OfOos, Inc., 1989 CA 20 48 (02-99) ACP BAP025-3-H04078 LYNO 14121 AaaNr COPY CA2448020900 4240 n seesaw COMMERCIAL AUTO CA 0444 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the fallowing: BUSINESS AUTO? COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name(s) Of Person(s) Or Organization(s): CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 The Transfer Of Rights Of Recovery Against Oth- ers Tc Us Condition does not a ply to the person(s) or organization(a) shown In the Schedule, but only to the extent that subrogation is waived prior to.ihe "so- cident" or the "loss" Under a contract with that person or organization. All terms and conditions of this policy apply unless modified by this endorsement. CA 04 44 0310 ® Insurance Services Office, Inc., 2009 Page i of 1 ACP BAPD06.3.6084678 LYND 14121 AGENT COPY CA0444031000 0200 25 0000846 COMMERCIAL AUTO AC 20 4107 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGECOVERAGEFORM SCHEDULE Name of Persons) or Organization(s): CITY OK SANTA ANA PUBLIC WORKS AGENCY M36 (If no entry appears above, information required to complete this endorsement will be shown in the Declare - tions as applicable to the endorsement.) A. "SECTIONII-'LIABIL'ITYCOVERAGE; Who Is An4neur,,od is<amended to include as an additional Insured for Liability Coverage: Each person or organization shown in the Schedule, but only to the extent that person or organlzatlon qualifies as an 'Insured". Loss must arlse out of ongoing operations performed for the Named Insured. B. SECTION IV- BUSINESS AUTO CONDITIONS SECTION V. GARAGE CONDITIONS The following paragraph is added to 8.5 of Otherinsuranco: a. If required by a written contract or written agreement executed before the "accident" occurred, any Insurance carried by the per- son or organization shown In the schedule shall be noncontributory with respect to the coverage provided to you. All terms and conditions of this policy apply unless modified by this endorsement. AC 20 41 07 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with Its permission CHAMB-4 OP ID: W2 '`'�, �`�'' CERTIFICATE OF LIABILITY INSURANCE 705/15/2015 TE 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(S), 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 Kaercher Campbell & Associates 1800 Century Park East #400 Los Angeles, CA 90067 Wendi Carpenter CONTACT PHONE FAX A/C No Ext): A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Insurance INSURED Chambers Group Inc. INSURER B: Commerce & Industry 19410 5 Hutton Centre Drive, Ste 750 DAMAGE TO RE= PREMISES Ea occurrence $ 100,00 Santa Ana, CA 92707 INSURER C D LIINSURER NSURER E: 06/01/2014 INSURER F: MED EXP (Any one person) $ 10,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE DDL SUER POLICY NUMBER CY EFF MM% POLID/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RE= PREMISES Ea occurrence $ 100,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X71 OCCUR X UVEDE104595114 06/01/2014 06/01/2015 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,00 X Pollution$1mil X Deduc $1,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 17 POLICY X PE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE PERACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE UMEDE104596114 06/01/2014 06/01/2015 AGGREGATE $ 4,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE V / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA WC065257206 05/12/2015 05/12/2016 X I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 - E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Error UVEDE104595114 06/01/2014 06/01/2015 Per Claim 1,000,000 & Omissions RETRO DATE - 1/1/1978 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured CHAMBERS GROUP INC, A-2013-007-02 REVIEWED BY: EUNICE HEREDIA (PG 1 OF 1) CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 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 City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Ana, CA 92702 l� G' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CHAMB-4 OP ID: W2 Afw" R® CERTIFICATE OF LIABILITY INSURANCE TE (MM/DD/YYYY) P05/27/2015 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(S), 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 Kaercher Campbell &Associates 1800 Century Park East #400 Los Angeles, CA 90067 Wendi Carpenter CONTACT .. NAME: PHONE FAX (A/C_ No, EExt D. INC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Insurance INSURED Chambers Group Inc. 5 Hutton Centre Drive, Ste 750 Santa Ana, CA 92707 INSURER B: Commerce & Industry 19410 INSURER C: INSURER D: EACHTE _ OCCURRENCE $ 1,000,00 INSURER E: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NI IMRFR- 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. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACHTE _ OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X UVEDE104595115 06/01/2015 06/01/2016 PREMISES Ea occurrDence) $ 100,00 _ MED EXP (Any one person) $ 10,000 X Pollution $117`111 PERSONAL &ADV INJURY $ 1,000,000 X Deductibel $2,500 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 POLICY X PRO JECT F] LOC I I Is AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) HIRED AUTOS NON -OWNED I AUTOS i PROPERTY DAMAG E I PER ACCIDENT $ $ — X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS -MADE UMEDE104596115 06/01/2015 06/01/2016 AGGREGATE $ 4,000,000 DED RETENTION $ _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A WC065257206 05/12/2015 05/12/2016 X WC STATU- OTH- TORY_UIvIITS ER — E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 — (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below — E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Error UVEDE104595114 06/01/2015 06/01/2016 Per Claim 1,000,000 & Omissions RETRO DATE - 1/1/1978 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured / CHAMBERS GROUP A-2013-007-02. REVIEWED BY: ��,.- /_a EUf�JICE HEREDIA (PG 1 OF 5) CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 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 City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Ana, CA 92702 _ v' © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CHAMB-4 OP ID: W2 14 �4C,"i R'C!' CERTIFICATE OF LIABILITY INSURANCE D 05/27/ 05/27/2200YYYY) 15 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(S), 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 Kaercher Campbell & Associates 1800 Century Park East #400 Los Angeles, CA 90067 Wendi Carpenter CONTACT PHONE FAX A/c No Ext): A/C No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURER A: Liberty Mutual Insurance INSURED Chambers Group Inc. ID 725102 INSURER B: INSURER C 5 Hutton Centre Drive, Ste 750 INSURER D : Santa Ana, CA 92707 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL SUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS 20 Civic Plaza GENERAL LIABILITY r/ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS - COMP/OP AGO $ I R POLICY7X,'P_ O- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO H ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE PER ACCIDENT $ $ — 1 BRELLA LIAB OCCUR EACH OCCURRENCE $ *DED CESS LIARHCLAIMS-MADEAGGREGATE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F---1N/A TORY LIMITS ER _ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under I E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Professional Error 104595115 i 06/01/2015 06/01/2016 Per Claim 2,000,000 & Omissions RETRO DATE - 1/1/1978 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CHAMFERS GROUP A-2013-007-02 REVIEWED BY: �i � EUNICE HEREDIA (PG 2 OF 5) CERTIFICATE HOLDER CANCFI I ATInN © 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2010/05) 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 City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Ana, CA 92702 r/ © 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company : Liberty Mutual Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # UVEDE104595115 relating to the following: I . The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 06/01/2014, this endorsement form as a part of Policy # UVEDE104595114 Issued to Chambers Group,Inc. Named Insured Countersigned by Authorized Representative CHAMFERS GROUP A-2013-007-02 REVIEWED BY: � ��, �' "� � m EUNICE. HEREDIAPG 3 OF 5 i ) POLICY NUMBER: UVEDE104595115 COMMERCIAL GENERAL LIABILITY Chambers Group, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. ADDITIONAL INSURED _- OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name nfPerson orOrganization: The City ofSanta Ana, 2UCivic Center Plaza, Santa Ana, California 027O1; its officers, employees, agents, volunteers and representatives are named as additional insureds (If no entry appears above, information required to complete this endorsement will be shown inthe Declarations oaapplicable tothis endorsemenL) WHO IS AN INSURED (Section U) is amended to include osen insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you CG2U1O11 85 Copyright, Insurance Services Office, Inc., 1984 CHAMBERS GROUP A,2U13-OO7-02REVIEWED BY: EUN|CEHERED|A(PG 4OF5) ' 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 Heredia-Espinoza, Eunice From: Boothe, Marilyn Sent: Tuesday, June 09, 2015 1:32 PM To: Heredia-Espinoza, Eunice Subject: Chambers Group Insurance appr/signature Attachments: GL -PL 6-1-16 WC 5-12-16 not appr.pdf A-2013-007-02 Due Date: 6/12/15 Please email a scanned copy to mboothe@santa-ana.org Thank you