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<br />CHAMB-4 OP I I: W2
<br />'`;� Rpt CERTIFICATE OF LIABILITY INSURANCE
<br />DA0612612013'O
<br />06!2512013
<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 endorsement sl.
<br />PRODUCER Phone: 310-556-1900
<br />Z ercher Campbell & Associates Fax: 310-556-4702
<br />1800 Century Park East #400
<br />Los Angeles, CA 90067
<br />Gary Lutz
<br />►"�� t711j "���
<br />NA E CT
<br />PHONE FAX
<br />C No (A/C,No):
<br />&MAIL
<br />A13DRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC 9
<br />INSURER A: Liberty Mutual Insurance
<br />INSURED Chambers Group Inc.
<br />5 Hutton Centre Drive, Ste 750
<br />Santa Ana, CA 92707
<br />INSURER a:Granite State Insurance Co.
<br />INSURER c: Commerce & Indust 19410
<br />INSURER D:
<br />INSURER E :
<br />INSURE F
<br />GUVtKAL9t, GtKIIFIGATE NLIM6ER_ RRVICInIU hII1M9r-P.
<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. NOTWTHSTANDING 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 />!NSR
<br />LTR
<br />TYPEOFINSURANCE
<br />DDLSUBR
<br />POLICY NUMBER
<br />LICY EFF
<br />M
<br />POLICY FXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 11000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Fx-1 OCCUR
<br />UVF-DE104595113
<br />06/01/2013
<br />0610112D14
<br />TO
<br />PREMISES aawurrence $ 100,000
<br />MED EXP (Any one on) $ 10,000
<br />PERSONAL 8 ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS-COMPIOP AGG $ 2,000,000
<br />PRO- LOC
<br />POLICY X JET F
<br />$
<br />AUTOMOBILE LIABILITY
<br />OMBINED SINGLE LIMIT
<br />Ea accident) $
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL ONMED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident $
<br />)
<br />NON-OMFD
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Peraccidenl S
<br />S
<br />X
<br />UMBRELLA LIARX
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,00
<br />A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />UMEDE104596113
<br />06!0112013
<br />06101/2014
<br />AGGREGATE $ 4,000,00
<br />DED RETENTIONS
<br />$
<br />B
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE❑
<br />OFFICERIMEMBEREXCLUDED?
<br />{Mandatory in NH)
<br />If yes, describe under
<br />N!A
<br />COSS267206 - CA
<br />WC065257205 - NV
<br />05112!2013
<br />05/12/2013
<br />05112/2014
<br />05112/2014
<br />v INC STATU- I JOTH-
<br />LIMITS I IFR
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE $ 1,400,00
<br />EL DISEASE -POLICY LIMB S 1,000,00
<br />DESCRIPTION OF OPERATIONS belay
<br />A
<br />Pollution
<br />UVEDE104595113
<br />06!0112013
<br />06101/2014
<br />Aggregate 2,000,00
<br />Liability
<br />Deduc 2,50
<br />ucA.rcif• Alun Vr VrCRA1aJN51 LV VAI IONS! VCMI(:LES [Anacn ACORD 101, Addilional Remarks Schedule, If more apace Is required)
<br />Che City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701;
<br />Lts officers, employees, agents, volunteers and representatives are named as
<br />additional insureds.
<br />3IR $50,000 Blanket Waiver of Subrogation applies as required by contract.
<br />CFRTIPICATF 41111 111=0
<br />f A M^—
<br />AppRoly) PS/"o
<br />o T/
<br />C-
<br />W
<br />LV 196H/-ZU1 U AGUKU GUKPURATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />-4r
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M36
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />LV 196H/-ZU1 U AGUKU GUKPURATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />-4r
<br />
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