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ACORL�a
<br />IIIC" CERTIFICATE OF LIABILITY INSURANCE
<br />ATE (MM/DD/YYYY)
<br />r6/25/2018
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />1255 Battery Street, Suite 450
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />A/C No Ext): 415-536-8617 AIC'No): 415-536-8627
<br />ADDRIESS:
<br />San Francisco CA 94111
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: American Fire and Casualty Company 24066
<br />INSURED CSGCONS-01
<br />CSG Consultants, Inc.
<br />550 Pilgrim Drive
<br />INSURER B: Arch Insurance Company 11150
<br />INSURER C: West American Insurance Company 44393
<br />INSURER D: Berkshire Hathaway Homestate Insurance Company 20044
<br />Foster City, CA 94404
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 307537323 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 REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />BKW(18)57695795
<br />12/412017
<br />12/4/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $ 500,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L
<br />O
<br />POLICY [ J PROF 7 LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />8AA(18)57695795
<br />12/4/2017
<br />12/4/2018
<br />CEa accOMBINidentED SINGLE LIMIT $ 1,000.000
<br />BODILY INJURY (Per person) $
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />A
<br />X UMBRELLA LIAB
<br />X
<br />OCCUR
<br />USA(18)57695795
<br />12/4/2017
<br />12/4/2018
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION $ 0
<br />1 $
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />CSWC821833
<br />12/4/2017
<br />12/4/2018
<br />X PER 0'_
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED?
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />B
<br />Professional Liability
<br />PAAEP0008802
<br />12/4/2017
<br />12/4/2018
<br />Each Claim $5,000,000
<br />retro date: 1/1/1991
<br />Aggregate $5,000,000
<br />Deductible: $50,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />re: RFP 17-083, agreement to provide engineering services on an on-call basis (general engineering) entered 6/19/18. City of Santa Ana, its officers,
<br />employees, agents, volunteers and representatives are included as additional insureds on a Primary & Non -Contributory basis on GL with 30 Day Notice of
<br />Cancellation per attached. 30 Day Notice of Cancellation on Auto & Professional per attached. 30 Day Notice of Cancellation on WC is not available. CG2010
<br />attached.
<br />REVIEWED BY: EUNICE HEREDIA (PG I OF )
<br />[yailLiChG1l7:C�]RJ3:1
<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, Clerk of the City Council ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M-30)
<br />PO Box 1988 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702-1988
<br />USA
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
<br />
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