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CHAMB-4 OP ID: W2
<br />sa`v�rc� CERTIFICATE OF LIABILITY INSURANCE
<br />OA0712412014Y)
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<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 DDES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND V. TEP#LVR4
<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, c§[tf�gol�5s y rI Ire an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorselh${(�. U �� ry�� ANA
<br />PRODUCER CLERK, OF rI r11' I
<br />Kaercher Campbell & Associates
<br />1800 Century Park East #400
<br />Los Angeles, CA 90067
<br />Wend! Carpenter
<br />CONTACT
<br />NAME:
<br />PHONE x A C No
<br />E-MAIL
<br />ADDRESS:
<br />INSURERIS), AFFORDING COVERAGE NAICk
<br />LIMITS
<br />INSURER A: Liberty Mutual Insurance
<br />GENERAL LIABILITY
<br />INSURED Chambers Group Inc.
<br />5 Hutton Centre Drive, Ste 750
<br />INSURER B: Granite State Insurance Co.
<br />Santa Ana, CA 92707
<br />INSURER C
<br />INNSSURED
<br />A
<br />IURERR E:
<br />X
<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 />SUBIR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDryYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X COMMERCIALGENERALLIABILITY
<br />CILAIMS-Iri OCCUR
<br />X
<br />UVEDE104595114
<br />0610112014
<br />06/0112015
<br />PREMISES Ea occurrence $ 100.00
<br />MED EXP (Any one person) $ 10,00
<br />X Polllution$lmilO
<br />F
<br />PERSONAL& ADV INJURY $ 1,000,00
<br />X Claims Made
<br />GENERAL AGGREGATE $ 2,000,00
<br />♦ �g!
<br />o
<br />GEN1 AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />titOv-�
<br />`
<br />,7 POLICY
<br />PRO -
<br />iECT LOC
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />3D 1
<br />�y�iat9l><► tC
<br />tT9k=
<br />AA!
<br />i+♦�
<br />v
<br />Ea accident SINGLE LIMIT
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />P RACCIDENT
<br />S
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 4,000,00
<br />AEXCESS
<br />LIAR
<br />CLAIMS -MADE
<br />UMEDE104596114
<br />0610112014
<br />0610112015
<br />AGGREGATE $ 4,000,00
<br />DEO RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECIJUVE YIN r7
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandalay In NH)
<br />Use, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />C065257206
<br />0511212014
<br />0511212015
<br />4VC STATU- OTH-
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,00
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />A
<br />Professional Error
<br />UVEDE104595114
<br />0610112014
<br />0610112015
<br />Per Claim 2,000,00
<br />& Omissions
<br />RETRO DATE - 11111978
<br />Aggregate 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 />ACORD 25 (2010105)
<br />©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 />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Public Works Agency M36
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010105)
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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