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?-•? ® DATE(MMIDD/Yl'YV) CERTIFICATE OF LIABILITY INSURANCE D6126I26,B THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri ghts to the ;= certificate holder in lieu of such endorsement(s) '? . PRODUCER CONTACT NAME: N 'a ADD Risk services Northeast, Inc. PHONE FAX New York NY Office NC. No. El): (g66) 283-7122 800-363-0105 NC.No.: 9 199 Water Street E-MAIL New York NY 10038-3551 USA ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC p INSURED INSURERA: Chartis specialty Insurance company 26883 Buck Consultants, LLC One Pennsylvania Plaza INSURER B: 29th Floor INSURER C: New York NY 10019 USA INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 5700500724 04 REVISION NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested ADD SUER INSR O ICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR MD POLICY NUMBER MMIOD MMIDDIYYYY) LIMIT S GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY PREMI =RENTED ISES Ee occurrence CLAIMS-MADE ? OCCUR MED EXP (Any one person) PERSONALS ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS SCHEOULEO AUTOS BODILY INJURY (Per accident) IRED U NON-OWNED A'P1ROVED rg+ yO FORM PROPERTY DAMAGE A H TOS AUTOS Peraccldent UMBRELLA LIM OCCUR C ------- EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE LISA E. STORCK AGGREGATE DED RETENTION n ASSIStant ity Attorr ey WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY YIN / TORY LIMITS E ANY PROPRIETOR/ PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? F- NIA L E.L. EACH ACCIDENT (Mandatory in NH) If en describe undo, E.L. DISEASE-EA EMPLOYEE y , DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT A E&O-PL-Primary 025827848 05/26/2013 05/26/2014 Aggregate $10,000,000 SIR applies per policy ter ns & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD ID1, Additional Remarks Schedule, if more space Is required) Named insured includes: Buck Consultants, LLC, 1455 Frazee Road, suite 805, San Diego, CA 92108 Re: Contract NO, N-2010-038 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Attn: Bich D. Ta, Supervising Accountant Finance & management services _ ? Finne nDivision Visisioon m-17 20 Civic center Plaza iG2a'e+.O T Santa Ana CA 92701 USA 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 3 V n 0 0 r w O 2 d V tG d O