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<br />CHAMB-4 OP ID: W2
<br />CERTIFICATE OF LIABILITY INSURANCE05!27/2014
<br />DATEIMMIDUIYYYY)
<br />WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEDD
<br />A BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEENN REDUCED BY PAID CLAIMS.
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />ATBY E
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED POLICIES
<br />BELOW. THIS GTF(7IIFIPATE� IN&UP*NQE7DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE"OR PRbb R,; TFIE ERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and con$htions of the policy,. cert8ijf dolicies may require an endorsement. A statement on. this certificate does not confer rights to the
<br />certificate holder n fieu of such endorserrlen�
<br />_
<br />PRODUCER - - ' " -_' `" ^ -
<br />Kaercher Campbell & Associates 1800 Century Park East #400
<br />Los Angeles, CA 90067
<br />Carpenter
<br />IJABILITV
<br />Ezt: FAX
<br />PWendi
<br />:INSURERS
<br />W-ING
<br />AFFORDING COVERAGEICA:
<br />LI be Mutual Insurancei
<br />INSURED Chambers Group Inc.
<br />Hutton Centre Drive, Ste 750Santa
<br />8: Granite State InSUranOe Co.5
<br />C:D
<br />Ana, CA 92707
<br />:
<br />X
<br />COMMERCIAL GENERALLABILI .
<br />INSURER E :
<br />dZ
<br />INSURER F
<br />z.v Y�RAcaw OCH I IFIGA I E NUMBER'
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CONDITION ANY CONTRACT OR OTHER DOCUMENT
<br />WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEDD
<br />A BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEENN REDUCED BY PAID CLAIMS.
<br />IN9R TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF POLICY EXP
<br />MMlBDIYYYY MMIDDIYYYY DMIT$
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />GENERAL
<br />IJABILITV
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Plaza
<br />Santa Ana, CA 92702
<br />EACH OCCURRENCE I$ 1,000,00
<br />A
<br />X
<br />COMMERCIAL GENERALLABILI .
<br />X
<br />UVEDE104595114 D6l0112014 06/01/2015
<br />PREMISES IE. ocw ante $ 100,00
<br />CLAIMS �
<br />MED EXP (Any one perscn) $ 10,00
<br />_I -MADE OCCUR
<br />X
<br />Polllution$lmil
<br />RSONALB ADV INJURY $ 1,000,00
<br />X Claims, Made
<br />F�
<br />-- -_.- --
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />AS
<br />iy
<br />P CTS - COMPIOP AGG S 2,000,00
<br />POLICY 1 PHO- x LOC
<br />Y 4O
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />_
<br />ANY AUTO
<br />�' S OA otiney
<br />Ea
<br />BOOILYoINJURY(Per $
<br />ALL OWNED r 'SCHEDULED
<br />t C1
<br />parser)
<br />BODILY INJURY(P_ erac
<br />AUTOS AUTOS
<br />NON-OWNED
<br />ism°
<br />PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS
<br />`+
<br />I
<br />_LPERACCIDEN
<br />$
<br />X UMBRELLA LIAR
<br />X OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,00
<br />A
<br />EXCESS UAB
<br />CUMS-MADE
<br />UMEDE104596114
<br />06/0112014
<br />06/01/2015
<br />$ 4,000,00
<br />AGGREGATE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITV
<br />WC STATU- OTH-
<br />XITS
<br />YIN
<br />EB
<br />B ANY PROPRIETORIPARTNERIEXECUTIVE �1
<br />OPFICERMEIdBER EXCLUDED' '.NIA
<br />WC065257206
<br />05/1212014
<br />05/1212015
<br />E.L. EACrrACCIDENT
<br />—_.
<br />$ 1,000,00
<br />E. L. DISEASE -EA EMPLOYEES
<br />.I
<br />an atorym H)
<br />If yes, desvib,I
<br />- _..__.—
<br />I-__ __ 1,000,00
<br />DESCRIPTION OF OPERATIONS nelow
<br />�I&Omisiions
<br />L. DISEASE - POLICY LIMIT $ 1,000,00
<br />q Error
<br />UVEDEE.
<br />06101/2014
<br />06/01/2015
<br />Per Claim 2,000,00
<br />&Omissions
<br />'RETRO
<br />RETRO ATE -11
<br />DATE - 1/111978
<br />!Aggregate
<br />2,000,00
<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 ("additional insureds") with regard to liability and
<br />defense of suits arising from the operations and uses performed by or on
<br />behalf of the named insured
<br />CERTIFICATE HOLDER CANCELLATION
<br />(9) 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Public Works Agency M36
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Plaza
<br />Santa Ana, CA 92702
<br />(9) 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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