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CHAMB-4
<br />OP ID: W2
<br />.ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (M4/20
<br />03/0/209
<br />19
<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 endorsements .
<br />PRODUCER 310-556-1900
<br />Kaercher Campbell & Associates
<br />600 Corporate Pointe, Ste 1010
<br />Culver City, CA 90230
<br />Wendi Carpenter
<br />CONTACT Gary Lutz
<br />NAME:
<br />PHONE
<br />o, Ext): 310-556-1900 FAx 310-556-4702
<br />(A/ C, No):
<br />E-MAIL
<br />ADDRESS:
<br />_ INSURER(S) AFFORDING COVERAGE _ NAIC #
<br />_
<br />INSURER A: Nautilus Insurance Company 17370
<br />SURD
<br />5 HuttFon Ce trepDr Inc.
<br />Ste 750
<br />Santa Ana, CA 92707
<br />INSURER B : Depositors Insurance Company 42587
<br />Commerce & Indust 19410
<br />INSURER C : Industry
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 />TYPE OF INSURANCE
<br />DDL
<br />UBR
<br />1. POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FvriX OCCUR
<br />_
<br />ECP202630310
<br />06/01/2018
<br />!
<br />06/01/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES a occurrence
<br />$ 100,000
<br />MED EXP An one person)$
<br />10,000
<br />X Pollution $2mil
<br />I
<br />XDeductible$2,500
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY [XI IT& LOC
<br />! GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />I $
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />$
<br />X ANY AUTO
<br />ACPBAPD3078827683
<br />06/01/2018
<br />06/01/2019
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />1 $
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />! $
<br />I
<br />A
<br />X UMBRELLA LIAB 1 X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />FFX2026322-10
<br />06/01/2018
<br />06/01/2019
<br />DED RETENTION $
<br />S
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />A
<br />NIA
<br />!
<br />WC065257206
<br />05/12/2018
<br />05/12/2019
<br />X PER OTH-
<br />STAT T ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />!
<br />E.L. DISEASE - POLICY LIMIT
<br />. $ 1,000,000
<br />A
<br />Professional Error
<br />UVEDE104595117
<br />06/01/2018
<br />06/01/2019
<br />Per Claim
<br />1,000,000
<br />& Omissions
<br />RETRO DATE-1/1/1978
<br />I
<br />Aggregate
<br />2,000,000
<br />!
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana, its officers employees, agencts and representatives
<br />are named additional insured as their interest may appear as respects the
<br />operation of the Named Insured.
<br />REVIEWED BY: EUNICE HEREDIA (PG OF )
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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