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<br />CHAMB-4 OF ID: W2
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />D0511212014ATE Y)
<br />05/12/2014
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CF,TIFIGA7F hL0¢DER, ,,, ;�.4 i
<br />IMPORTANT: If the certificate holder is an ADDf IONAU'iN$tJ ED; the ppllcv(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 endorsemenf s ,
<br />PRODUCER
<br />Kaercher Campbell&Associates
<br />1800 Century Park East 41400
<br />Los Angeles, CA 90067
<br />Wendi Carpenter
<br />CONTACT
<br />NAME.
<br />PHONE ac No:
<br />E-MAIL
<br />ABnRESS:
<br />INSURERS AFFORDING COVERAGE NAIC4
<br />INSURER A: Liberty Mutual Insurance
<br />INSURED Chambers Group Inc.
<br />5 Hutton Centre Drive, Ste 750
<br />Santa Ana, CA 92707
<br />r
<br />'•s I tJ ~0 0
<br />INSURER B: Granite State Insurance Co.
<br />INSURER c:Commerce &Industry 19410
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />BUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIOOIYYVY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />Ce
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,900
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />WERE104595113
<br />06/0112093
<br />06/0112014
<br />°PREMISES Ea 000urrence $ 100,000
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />} S
<br />VL®V VD
<br />VO
<br />GENERAL AGGREGATE $ 2,000,000
<br />GBN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO- LOC
<br />PRODUCTS_COMP/OP AGG $ 2,000,000
<br />$
<br />AUTOMOBILE
<br />,,,
<br />LIABILITY
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NON-ONINED]
<br />AUTOS
<br />ILI p
<br />psststan t city
<br />v
<br />C[e
<br />torney
<br />%
<br />`/°_✓_�,PROPERTYDAMAGE
<br />COMBINCO SINGLE LIMIT
<br />BODILY INJURY (Per parser) $
<br />-
<br />BODILY INJURY (Per accidenQ $
<br />PER ACCIDENT $
<br />{j
<br />X
<br />UMBRELLALIAS
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />UMFDE104596113
<br />06/0112013
<br />06/01/2014
<br />DEp RETENTION
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFMCERIMEMEER EXCLUDED?
<br />(MandatcC,RNH)
<br />NIA
<br />WC065257206
<br />05/1212014
<br />05/1212015
<br />X WC STATOTH-
<br />TO U U- ER
<br />E.L. EACH ACCIDENT $ 1,000,090
<br />'-
<br />E, L. DISEASE EA EMPLOYEE $ 9,009,909
<br />If yes describe
<br />OCSGtRIPTION OF OPERATIONS below
<br />EL DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Pollution
<br />UVEDE104595113
<br />D6/01/2013
<br />06/01/2014
<br />Aggregate 2,000,000
<br />Liability
<br />Deduc 2,500
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701;
<br />its officers, employees, agents, volunteers and representatives are named as
<br />additional insureds.
<br />SIR $50,000 Blanket Waiver of Subrogation applies as required by contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<br />b 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />20 Civic Center Plaza, M36
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />Ce
<br />ACORD 25 (2010/05)
<br />b 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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