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<br />CERTIFICATE OF LIABILITY INSURANCE
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<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
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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 DOES 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 poltcyjfes) 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 endorsement(s).
<br />PRODUCER
<br />C Campbell 8, Associates
<br />1800 1800 Century
<br />tury Park East #400
<br />Los Angeles, CA 90067
<br />Wendt Carpenter
<br />CON•ACT
<br />NAME:
<br />PHONE o me No:
<br />E -NI L
<br />ADDRESS: _
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />GENERAL LIABILITY
<br />INSURERA: Liberty Mutual Insurance
<br />INSURED Chambers Group Inc.
<br />5 Hutton Centre Drive, Ste 750
<br />Santa Ana, CA 92707
<br />INSURERS: Granite State Insurance Co.
<br />:NSURERC:Commerce & Industry 19410
<br />INSURER 0:
<br />X CDMMERCIAL GENERAL LIABILITY
<br />INSURER E:
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<br />INSURER F
<br />COVERAGES LICK IIFR:A I C N'IUMBI=R: GCVImOM yr IRMO On
<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 />ILTR TYPE OFIN$URANCE D
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICY NUMBER
<br />MNINYYYY
<br />MMlDMYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />IMRffUffRF
<br />EACH OCCURRENCE $ 1,000,00
<br />A
<br />X CDMMERCIAL GENERAL LIABILITY
<br />UVEDE104595113 08101/2013
<br />06/01/2014
<br />PREMISES EaoccvrtercaS 100,00
<br />CLAIMS -MADE a OCCUR
<br />MED EXP (Any one Poo l S 10,00
<br />PERSONAL& ACV INJURY $ 1,000,00
<br />GENERAL AGGREGATE $ 2,000,0
<br />AS TO
<br />1"y
<br />GEN'L AGGREGATE _IMT APPLIES PER:
<br />PRODLCTS-COMP/OPAGG $ 2,000,0
<br />Y
<br />RO Y
<br />POL.'Y X PRO- LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />r
<br />COMBINED SINGLE LIMIT
<br />(ED acbidw
<br />ANY AUTO
<br />L`Y'
<br />BODILY INJURY (Papalson)
<br />ALLOWNED SCHEDULED
<br />ptorney
<br />nt tatty
<br />-
<br />fi$
<br />BODILY INJURY Par acmdenl) $
<br />....
<br />AUTOS AUTOS
<br />HIRED AUTOS NCV-0NINED
<br />AUTOS
<br />Ae$15ta
<br />PROPERTY DAMAGE
<br />PER ACCIDENT S
<br />3
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH 02CURRENCE f$ 4,000,00
<br />A
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />UMEDE104596113
<br />06/01/2013
<br />06101/2014
<br />AGGREGATE S 4,000,00
<br />DED RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />X WCSTATU- OUR
<br />EMPLOYERS' LIABILITY
<br />YIN
<br />_
<br />EL. EACHACCIDENT S 11000,00
<br />---.
<br />B
<br />WC065257206
<br />05112/2014
<br />05/1212015
<br />OFRCERAILMDER EXCLUDED' ;NIA
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,00
<br />IANYPRCPRIETCRJPARTNERIEXECUTIVE
<br />(Bandana, in NHI
<br />dosry
<br />ryeeRIPTI
<br />EL DISEASE - °GLIDY LIMIT $ 1,000,00
<br />NuMer
<br />DE$�RIPTION OF OPERATIONS below
<br />A
<br />Pollution
<br />UVEDE10459BIl
<br />06/01/2013
<br />06/01/2014 Aggregate 2,000,00
<br />Liability
<br />Deduc 2,500
<br />DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarlu Schedule, houni space is racclred)
<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 />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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<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 />20 Civic Center Plaza, M36
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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