Loading...
HomeMy WebLinkAboutCHAMBERS GROUP, INC. 2CC 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TERMINATION FORM ni-A Please complete this form when the attached agreement and all Q �k N amendments (if any) are no longer in effect.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: 0,48VRANCL.ON FILE MAYOR WORK MAY PROCEED Miguel A. Pulido UNTIL INSURANCE EXPIRES MAYOR PRO TEMt—( (0 Vincent F. Sarmiento gm _ } i COUNCILMEMBERS CLERK OF COUNCIL-..-�...w.._ Angelica AmeZCUa DATE' P. David Benavides Michele Martinez Roman Reyna Sal Tinajoro CITY OF SANTA AAI A PUBLIC WORKS AGENCY 20 Civic Center Plaza M-36 s P.O. Box 1988 M-36 Santa Ana, California 92702 vwww.santa-ana.ora December 8, 2015 Chambers Group, Inc. 5 Hutton Center Drive, Suite #750 Santa Ana, California 92707 Re: Environmental Consultant Services Agreement A-2013-007 A-2013-007-03 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, 2015 until December 31, 2016. 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 Jason Gabriel at 714-647-5664. Sincerely, Mousavipour Ave Director Works Agency ndoval4jle sistant City Attorney ATTEST: ATTEST.- MARIA c). HUIZAR MAFIA G. HUIr.AR OUNCIL CLERK OF THF COUN `,IL SANTA ANA CITY COUNCIL Miguel A. Porde ( vans l P. 8ermtento I Whale Martinez i Aigalioa Amezeua i P. David aenawdes i Roman Reyna 1 Sa, Tinalem Mayor i Mayer Pro Tem, Wank W»rd'2 i wad Ward i Ward Wad B MW6tlok�sania-ana.ora iVSaem'enio[Bsa�fa-aas era A ,iarineztasanta-an».are AAmezcuab)saota-arra arg i DBMpA 3�sazNa- ... i RRewaA+ rda-ane as i 5+naterakileanfiz-ana.oro December 8, 2015 Chambers Group, Inc. 5 Hutton Center Drive, Suite #750 Santa Ana, California 92707 Re: Environmental Consultant Services Agreement A-2013-007 A-2013-007-03 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, 2015 until December 31, 2016. 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 Jason Gabriel at 714-647-5664, Sincerely, Public Works Agency Sandoval \ Assistant City ATTESM _M 4444 o. /1v MARIA r4 P-1I,PIZAR r? SANTA ANA CITY COUNCIL `ft.e"4 mMquar A. PMAI) V vl cam P. Saamans i Mrhsie Manner Angelica Ameuua P. U3"d Roman Reyna i SAF Tt.Wb mayor i Maya, Pru T., Wadi Wad 2 VJar*l3 WaN 3 3 W aa15 i Wad $ impngygjopsanta-ane o(9i YSarm entINtil„ga., nla-ate j MMnrCnei(a;SyR -a rao /yRryi zraa _sS2�1 gm1 Q-2 soma- 9qSi RRama(�" n ana�prg i ^P,'u aer sav{ n, gy MAYOR Miguel A. Pulidu MAYOR PRO TEM - Vincent F. Sarmiento COUNCILMEMBERS Angelica Amezcua r;•: t P. David Benavides Michele Martinez Roman Reyna " SalTinaaerc CITYOF JAV T(A AAA PUBLICWORKS AGENCY 20 Civic Center Plaza M-36 - P.O. Box 1988 M-36 Santa Ana, California 92702 vvwv.santa-ana.arg December 8, 2015 Chambers Group, Inc. 5 Hutton Center Drive, Suite #750 Santa Ana, California 92707 Re: Environmental Consultant Services Agreement A-2013-007 A-2013-007-03 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, 2015 until December 31, 2016. 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 Jason Gabriel at 714-647-5664, Sincerely, Public Works Agency Sandoval \ Assistant City ATTESM _M 4444 o. /1v MARIA r4 P-1I,PIZAR r? SANTA ANA CITY COUNCIL `ft.e"4 mMquar A. PMAI) V vl cam P. Saamans i Mrhsie Manner Angelica Ameuua P. U3"d Roman Reyna i SAF Tt.Wb mayor i Maya, Pru T., Wadi Wad 2 VJar*l3 WaN 3 3 W aa15 i Wad $ impngygjopsanta-ane o(9i YSarm entINtil„ga., nla-ate j MMnrCnei(a;SyR -a rao /yRryi zraa _sS2�1 gm1 Q-2 soma- 9qSi RRama(�" n ana�prg i ^P,'u aer sav{ n, gy CHAMS-4 OP ID: V12 AC --"(4 LY ... " CERTIFICATE OF LIABILITY INSURANCE v GATE (MMIDnrVYYY} CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, oer2n2 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 CONTACT NAME: Kaercher Campbell &Associates PAX PHONEg,Sxti" 1 BOO Century Park rest 9400 I LA '— Los Angles, CA 90067 E-MAIL WendiCarpenter AceREss: _ INSURERS AFFORDING COVERAGE _ NAiCa INSURER A: Liberty Mutual insurance INSURED Chambers Group Inc. INSURER e: Commerce & Industry 19410 6 Hutton Centre Drive, Ste 750 INSURER C Santa Ana, CA 92707 INSURER 0: _ INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: RFvIRION NIIMFUrp. 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 01 HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF. 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 _ R _ TYPED, INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS.. P LCY P,L`_ POUCY NUMBER fN OD Y _PS - _.._ YYYY) LORTa GENERAL. UABIUTY 20 Civic Plaza Santa Ana, CA 92702;,`- EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY X UVEDE104695115 0610112019 0610112010 NITRUf PREMISES Ea ITTED $ 10000 �.�_. GLAIMS^MADE � OCCUR MED EXP(Aly oas etson} $ 10,00 X Pollution,$lmtl PERSONAL &ADV MJURY $ 1,000,00 X DedLlCtlbe1$2,500 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COONCE AGO $ 2,000,000 p01.ICY X PRG" � LOC $ AUTOMOOILC LIABILITY _ COMBINED SINGLE LIMIT Ea accident ANY A111'0 BODILY INJURY (Par person) $ ALL OWNED SCHEDULED- AUTOS AUTOS BODILY INJURY(Peraccidri $ NON -OWNED HIRED AUTOS ._.... P OPERTV DAMAGE $ AUTOS � PFR ACCIDENT) I $ X UMBRELLA LIAR X OCCUR EACH OCGVRREN=E 3� 4,000,000 A ExcEss UA9 CtAIMS-MADE UMEDE104896115 06101/2016 0610112016 AGGREGATE 54,000,00 $ ............_ DED1 ..............1_RETENTION$ WORKERS COMPENSATION WC STATU- OTN- X AND EMPLOYCRVLiASiLiTY YIN „�,, ,, B ANY PROPRIETCRPARTNERIEXECUTIVE VVC065267206 0511212019 0611212016 ESL EACHACCIDENT s 1,000,00 OEFICER/MCMaER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If gyas deserbe undo,' DUST l P@RATIONS below .......--^_.-� EA. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Error UVEDE1045DS114 06/0112016 _ 06/0112016 Per Claim 1,000,000 & Omissions RETRO DATE - 111/1978 Aggregate 2,000,000 DESCRIPTION ON OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 1 d1, AddRienai Romarks Schu, Wa, If mora space Is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 927011 its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insuxeds") 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: fls - d/ " d r EUNICE HEREDIA (PG 3 OF 5) CERTIFICATE HOLDER CANCELLATION 0 1988.2090 ACORD CORPORATION. All rights reserved, ACORD 26 (20101061 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF ]'HE 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 REPRESENTATIVEY 20 Civic Plaza Santa Ana, CA 92702;,`- lr 0 1988.2090 ACORD CORPORATION. All rights reserved, ACORD 26 (20101061 The ACORD name and logo are registered marks of ACORD CHAN13 4 OP ID: W2 CERTIFICATE OF LIABILITY INSURANCE 005127120/ YY) 05127!8015 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 statemant on this certificate does not, confer rights to the certificate holder 1n lieu of such endorsemen s . PRODUCER Kaercher Campbell & Associates 1800 Century Park East #400 Los Angeles, CA 90067 Wendi Carpenter CONTACT NAME: _ PH o 1: alc, Nol a MAIL ADDRESS: ._- (,MOLIC/YYYYI WRDI INSURERSAFEORDiNGCOVERAGE MAIC INSURER A I Liberty Mutual Insurance GENERAL LIABILITY INSURED Chambers Group Inc. ID 725102 5 Hutton Centre Drive, Ste 750- INSURER R: Nsuses D - Santa Ana, CA 92707 INSURER 4: INSURER E: INSURER CCRTRLR'- Tt'd�' PREW ES(Ee occurrence) 3 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 INeJURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 5UBJECT TO ALL THE TERMS, EXOLUBIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R _ADD[BUSH ��TPE! TYPEOF INSURANCE POLICY NUMREPo (,MOLIC/YYYYI WRDI MMI_0,p(YVYY LIMITS GENERAL LIABILITY 3 EACH OCCURRENCE S COMMERgAd. GENERAL LIABILITY CCRTRLR'- Tt'd�' PREW ES(Ee occurrence) 3 01 AIMS OCCUR MED EXP(Anyone person) $ PERSONAL E ADV INJURY $ _ m b- GENERAL AGGREGATE GEN'L AGp2EGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY .i" PRD- , LOC _... $ . AV OMOWLE LIABILITY COMUINF-O SINGLE LIMIT Eo na: demi $ ,., ANY AUTO BODILYINJURY(Perpouon) $ ALLOWNED SCHERVLED" AU -103 AUTOS BODILY INJURY {Px ecc'ai -ont} & NON -OWNED PRDPE YDAMAGE$ HIREDAUTOS AUTOS PER ACCIDENT $ UMORELI-A LIAR OCCUR - EACH OCCURRCNCE $ EXCESS LIAa CI.AIASSMAD'c T __— 'I AGGREGATE $ — DEQ- I RETENTION,'/, $ WORKERS COMPENDATIONWC STATU- 07H" AND EMPLOYERS' UAOIUTY YIN -QaY ANYQPFICERUICNIC 'CROREXGLINJ02CFi4 ECUTIVE E.L, EACH ACCIDENT $ ❑ NJA _ {Mandatary St NH) FL, DISEASE -EA EMPLOYEE $ R yye0. aedp6w under _. _ . _..� DE6CR{PTI NOF OPERATIONS below E,L. DISEASE LIMIT $ A Professional Error _ UVEDE104695116 06/01/2015 06/01/2016 Per Claim 2,000,00 &.Omissions RETRO DATE -1/111978 Aggregate 2,000,00 DESCRIPTION OF OPERATION& t LOCATIONS t VEHICLES {Attach ACORD tOt, Adtlitianal RemarkJJs//Schetlule, it more space is requketl} ,f CHAMBERS GROUP A-2013-667-02 REVIEWED BY: y r f _ EUN3CE HEREQIA (PC 2 OF 5) City of Santa Ana Public Works Agency M36 20 Civic Plaza Santa Ana, CA 82702 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE )a 6-< /-&- @ 1988-2010 &- ©1988-2010 ACORD CORPORATION.. All rights reserved. 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 4 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 CHAMBERS GROUP A-2013-007-02 REVIEWED BY: /t � kl� - EUNICE HEREDIA (PG 3 OF 5) POLICY NUMBER; UVEDE104595115 COMMERCIAL GENERAL LIABILITY Chambers Group, Inc. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART, SCHEDULE Name of Person or Organization: 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 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section ll) is amended to include as an 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. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 CHAMBERS GROUP A-2013-007-02 REVIEWED BY: ��, EUNICE HEREDIA (PG 4 OF 5) CQh'L? CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) AD EFF POLI -EXP MIGU MMIDDlYYYY1 LIMITS 06!0912015 THIS CERTIFICATE 15 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(9), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polloy{les) must bo endorsed, If SUBROGATION IS WAIVED, subJeDl tD 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 NATIONWIDE SALES SOLUTIONS INC _q NIACT AMEN__ PHONE FAX .LNc Nn exd' — –N9.No1: " EMAIL App3,eSS: 1200 LOCUST ST DES MOINES IA 50391-9995 INSURER(S) AFFORDING COVERAGE NAICp INSURER AI DEPOSITORS INSURANCE COMPANY 42587 INSURED INSURER BI INSURER Q : S CHAMBERS GROUP, INC INSURER o: 5 HUTTON CENTRE OR STE 750 INSURERS:SANTA ANA CA 92707-8720 1 NSURERFI COVERAGES CEKIIFIGAIt NUMLdiol<: RFVIRV1Md WHIMAVD. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEC. 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 19 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM9, INSR TYPE 9PINSURANCE 'A56L1aTIeR�— P POLICY NUMBER AD EFF POLI -EXP MIGU MMIDDlYYYY1 LIMITS COMMERCIAL GENERAL LIABILITY ---� CLAIMS -MADE `_ OCCURS I EACHOCCURRENCE S Y'R''--�-� ON0.1pd'EBwENY@Yi P E.M1tGF9-Lifortrenpol S MED EXP(AnYone PBnia� h�^.• _._.— _— ............. ..._..-_ i PERSONAL& ADV INJURY S I GEN'LAGOREGATEMNITAPPLIESPER: r POLDY, "111T , I LOC I GENERAL, AGGREGATE $ PRODUCTS-COMPIOPAOC S S OTHER; AUTOMOe1LE LIAEILITY I EaNISIN 0STINGL LIMIT - 5 1,000,000 A XANY x AUTO ,ALL OWNED F- SCHEDULED - AUTOS y AUTOS j ACP RAPID 2545OB4678 HIRED AUTOS iXy AUTOS F0 06101/2015 BODILY INJURY (Pon poniard S �—'-'--" 06101/2016 i OODILY INJURY (For oo-nent) 5 eOPERffffdTYiii AMAGE- S UMBRELLA UAa i= OCCUR j EACH OCCURRENCE S EXCESS LIAM_ _ CAIMS-MADE RETENTIONS AGGREGATE $ - S OED WORKERS COMPENSATION IAND EMPLOYERS' LIABILITY YIN,i I OFF(CERINIEMDER EXCLUDE 01 ❑;NIA,' (Miadamry In NH) IlyoN s, deorriOFOPERATIONS belowE.L. SC IPTID EOF O E DTH- UT AANYPROPRIETOWPARTNEWEXECUTNE E.L EACH ACCIDENT 3 S.L. DISEASE - EA EMPLOYE S DISEASE -POLICY LIMIT 5 DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (ACORN 101, Additional Ramarka SchodIA0, may bo allaahad If mom epaap la aXtUa,d) City at Santa Anna IS jiated eS Certllleate holder only. Waiver of subrogation applies per form CA0444. CHAMBERS GROUP A-2013-007-02 REVIEWED BY: (/� �v EUNICE HEREDIA (PG 5 OF 5) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL RE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Anna•Publlc Works Agancy M36 20 Civic Plaza StephanieZED SoppRUPREeENTATIVE Stephanie Soppe t� Santa Anna CA 92702 < ,r_ V ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD reserved, CHAMB-4 OP ID: W2 ,4`coRca► CERTIFICATE OF LIABILITY INSURANCE706/02/2016(MMIDDIYYYY)TE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 : IA/C, No EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # X INSURER A: Liberty Surplus Insurance Corp 06/01/2016 INSURED Chambers Group Inc.- INSURER B: Commerce & Industry Ins Co 19410 5 Hutton Centre Drive, Ste 750 1 Santa Ana, CA 92707 INSURER C: INSURER D: INSURER E INSURER F: PERSONAL & ADV INJURY_ $ 1,000,000 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 DD-LLSUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY X '.. COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X UVEDE104595116 06/01/2016 06/01/2017 EACH OCCURRENCE_ $ 1,000,000 PREM SES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 X '.. Pollution $2mil ( PERSONAL & ADV INJURY_ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 X Deductible $2,500 PRODUCTS - COMP/OP AGG ( $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY _X...I PRO- LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT _(Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS ! ! i BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT $ X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE UMEDE104596116 06/01/2016 06/01/2017 AGGREGATE $ 10,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) I N / A 1,I ! !i, WC065257206 05/12/2016 05/12/2017 X 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 UVEDE104595116 06/01/2016 06/01/2017 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 92702; 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 . f r ....._.. . _- .. REVIEWED _B /Y-_. �� f ELJN' E- HE REDE A - ....:Iit3 � of City of Santa Ana Public Works Agency 20 Civic Plaza M-36 P.O. Box 1988 M-36' Santa Ana, CA 92702 UANGtLLA I JUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 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 G1 -,"NERAL LIABILITY POLICY Insurance Company: Liberty Mutual Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy #UVEDE1 04595 1 1 6 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 regards 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 if 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 of not so included, 4. With respects to the additional insureds, this insurance shall riot 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: 6/01/2016, this endorsenient form as a part of Policy #UVEDE] 04595116 Issued to Chambers Group, Inc, Named Insured Countersignature by: Authorized Representative DIA (PGZ-0F REVN.-WED BY 4 -E IER E . ....... ........ POLICY NUMBER: UVEDE104595116 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i WITAI 04 - This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Operations The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents, volunteers and representatives Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance Of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. RE.Vpfl.VOfED BY4 /1 AC"R" DATE (MMIDDlYYYY) CERTIFICATE LIABILITY INSURANCE 06/03!2016 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 endorsement(s). PRODUCER I CONTACT 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: 'iAODLSUBR' LTR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER MMIDDNYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY,,', EACH OCCURRENCE $ T ! _� CLAIMS MADE OCCUR DAMAGE TO RENTED ____) PREMISES (Ea occurrenceZ_ .G, ._______ . _------ --- ---- - --...---------- l ! MED EXP (Any one person) $ PERSONAL & ADV INJURY $ I L V _I E LIMIT APPLIES PER GENERAL AGGREGATE $ t...._ „ _� POLICY EOT LOC .. _..._ .... PRODUCTS COMP/OP AGG $ -- --._ --- --..-_...- -._._- 1 OTHER:,, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _______ ANY AUTO BODILY INJURY Per person) $ J ( P ) ALL OWNED SCHEDULED A AUTOS AUTOS X BODILY INJURY (Per accident) ACP BAPD 2555084678 06/01/2016 06/01/2017 $ II NON -OWNED HIRED AUTOS /'� I L 1 AUTOS - PROPERTYDAMAGE - - (Per accident___- I$ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ - _- EXCESS LIAB CLAIMS -MADE! L—----'— —- I ------------ AGGREGATE ---- ..... _.--._— --_.__............._-- DED -, RETENTION $ . 5...._.....-- WORKERS COMPENSATION 1 PER OTH- I AND EMPLOYERS' LIABILITY YIN❑, STATUTE ER _ ANYPROPRIETOR/PARTNER/EXECUTIVE '�, /"� E.L.EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N IA in NH) -- ---- -- - /,, (Mandatory If yes, describe under _., _ .. _.E L DISEASE EA EMPLOYEE, $ J f DESCRIPTION OF OPERATIONS below G-ZIEV4L.VVL..Ct BY ,�j Q EUNI E I (1...RE 1 (PG �6I ) ✓. _ ..._.-_ . _. b..._ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) %,cm l lrlt../i i c nVLLlcm City of Santa Ana 20 Civic Center Piz # M-36 Santa Ana CA 92701-4058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lyssa Yadvish 071988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD