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<br />A�fIL) CERTIFICATE OF LIABILITY INSURANCE
<br />DAie IMMIDOM'YYI
<br />TYPE OF INSURANCEPOLICYNUMBER
<br />06/2512013
<br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />CERTIFICATE DOES NOT TE OF INSURANCE
<br />BELOW. THIS CERTIFICATE E INSURANCE DOE5 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(lea) must be endorsed. If SUBROGATION I$ WAIVED, subject to
<br />the tens 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 endorsements).
<br />PRODUCER Phone: 310.556-1900
<br />Kaercher Campbell & Associates
<br />1600 Century Park East X400 Pax: 310-656.4702
<br />GarLos y ea, CA 90067
<br />Lutz
<br />rY.....
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />.._
<br />IFyRugRE I' A'�----
<br />No Etll• IMP, Ndl:
<br />16c;�L -
<br />INSURERS AFFORDING COVERAGE NAICS
<br />OENERALLIABNTY
<br />X CAMMFRCIAL GENERAL UA61UIY
<br />nXOOCUR
<br />INSURER A:Llb Mutual Insurance
<br />___
<br />INSURED ham ers Group Inc.
<br />6 Hutton Centra Drive, ate 760
<br />Santa Ana, CA 92707
<br />INSURER B: 0ranite State Insurance Co.
<br />INsuReRC:Commen:e & Indus!!g 19410
<br />INSURER 0:
<br />EACH OCCURRENCE 111000,000
<br />INSURER E:
<br />MED ESP An one euonJ S 10,000
<br />INSURE
<br />CLAIMSAADE
<br />COVERAGES CERTIFICATE 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 />Lm
<br />TYPE OF INSURANCEPOLICYNUMBER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />POL Y F
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />LINTS
<br />A
<br />OENERALLIABNTY
<br />X CAMMFRCIAL GENERAL UA61UIY
<br />nXOOCUR
<br />Santa Ana, CA 62702
<br />UVED2104696113
<br />0610112013
<br />06/0112014
<br />EACH OCCURRENCE 111000,000
<br />PREVETO-REgM M7® 5 100,00
<br />MED ESP An one euonJ S 10,000
<br />CLAIMSAADE
<br />PERSONAL, a ADV INJURY S 1,000,00
<br />GENERAL AOGREGATE S 2,000,00
<br />GENL AGGREGATE
<br />POLICY
<br />LIMIT APPLIES PER.
<br />51 PRO. LOC
<br />PRODUCTS-COMM?AGO S 2,000,000
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />I NUL —Ll M-
<br />aeccMen s
<br />BODILY INJURY(PUPeuun) S
<br />ANY AUTO
<br />ALL OMMEP SCHEOULED
<br />AUTOS AUTOS
<br />HIREDAUCS NON -OWNED
<br />AUTOS
<br />--
<br />BODILY INJURY (Per mldoni) S
<br />PROPERTYD
<br />lPintAcIdenh S
<br />A
<br />X
<br />UMBRELLA LIAO
<br />EXCESSLIAB
<br />X
<br />OCCUR
<br />CLAIMS MADE
<br />MEDE104596113
<br />06101/2013
<br />0610112014
<br />EACHOCOJRRENCE S 4,000,000
<br />AGGREGATE 1 4,000,000
<br />DED RETENTION
<br />5
<br />B
<br />C
<br />COMPENSATION
<br />AND KERS EMPLOYERS'
<br />AND EMPLOYERB'LUIBILITY YIN
<br />ANY PROPRIETOINPARTNFRIEXECUI'NE
<br />pddMn)ILWEDv ❑tinuy NN
<br />Mer
<br />II tAeeclBo VF
<br />S RIPrI FOPEMTIONS UeIaw
<br />NIA
<br />COSS267206 - CA
<br />COSS297206-NV
<br />Otif1212013
<br />0511212013
<br />0511=014
<br />06(12/2014
<br />NC BTATU- TRH
<br />X R
<br />---
<br />BL EACHACCIOENT S 1,000,00
<br />_
<br />E.L. DISEASE, EA EMPLOYE S 1,000.00
<br />EL DISEASE-POUCY LIMIT S 1,000,00
<br />A
<br />Dilution
<br />Llability
<br />�VEDE`10459611113
<br />08101/2013
<br />0610112014
<br />Aggregate 2,000,00
<br />Deduc 2,50
<br />DESCRPT M OF OPEMTIMS J LOCAMMS I VEHICLES (AtbcA ACOAO IDI, Atltllllonal Ramulu 9cMdule, If mon epee LL repulrotll
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701;
<br />its offioera, employees, agants, volunteers and representatives are named as
<br />additional insureds. �-.��
<br />SIA $50,000 Blanket Waiver of Suhrogation applies as required by contract. APp,RO I-' }`v5 ,j-
<br />G
<br />A K STORCK
<br />CERTIFICATE HOLDER
<br />r.AMrFi r ATInN
<br />61988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOA
<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 />AUTHORIZEOREPRESENTATIVE
<br />Santa Ana, CA 62702
<br />� Gig
<br />61988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD
<br />
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