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qCCOR H CERTIFICATE OF LIABILITY INSURANCE
<br />DIYYYY'
<br />7/28/2014
<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 policy(les) 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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />1255 Battery Street, Suite 450
<br />CONTACT
<br />NAME:
<br />PRONE 415-536-8617 FAX .415-536-8627
<br />Ext)L
<br />EMAIN
<br />INSURERS AFFORDING COVERAGE NAIC A
<br />San Francisco CA 94111
<br />INSURER A:Travelers Property Casualty Cc of A 25674
<br />INSURED CSGCONS-01
<br />INSURER B:C ress Insurance Company CA 10855
<br />CSG Consultants, Inc., Precision Inspection - CSG
<br />INSURERC:Arch Insurance Company 11150
<br />1700 S. Amphlett Blvd, 3rd Floor
<br />San Mateo, CA 94402
<br />INSURER D:
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 14401408 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
<br />Ned
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDO/YYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />580294MO850
<br />12/4/2013
<br />12/4/2014
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS-MADE1XI OCCUR
<br />PREMIETORENTEO
<br />PREMISES dbp�n.rba) $1,000,000
<br />MED EXP (Any ane person) $10,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE .$2,000,000
<br />POLICY PES E LOC
<br />APPROVED AS T®Fill
<br />ORM
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />a
<br />OTHER'.
<br />A
<br />AUTOMOBILE
<br />LIABILITYCOMBINED
<br />BA461 61
<br />1214/2013
<br />12/4/2014
<br />SINGL IT
<br />Ea accident $1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOttBODILY
<br />HIRED AUTOS X NON -OWNED IODG
<br />AUTOS
<br />- oil
<br />A At AI10
<br />14
<br />0y
<br />INJURY (Per accident) $
<br />-PROPERTY-DAMAGE $
<br />Per accitlent
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />CUP4177TI 23
<br />12/4/2013
<br />12/4/2014
<br />EACH OCCURRENCE $5,000,000
<br />AGGREGATE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />Following Form I $
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS' LIABILITY YIN
<br />3300065922131
<br />12/4/2013
<br />12/4/2014PER
<br />0TH-
<br />X` STAT UTE ER
<br />ANY
<br />OFFICERAEMBEER EXCLUDED?ECUTIVE
<br />INI
<br />NIA
<br />LLC-ACH ACCIDENT $1,000,000
<br />E.L. DISEASEEAEMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />C
<br />Professional Liability
<br />AEP004731502
<br />12/4/2013
<br />12/4/2014
<br />Each Claim $3,000,000
<br />retro date: 1/1/1991
<br />Aggregate $3,000,000
<br />Deductible. $50,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
<br />re: consultant agreement for municipal plan check services. 30 Day Notice of Cancellation on Professional Liability has been requested from
<br />carrier.
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) 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, Clerk of the City Council
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M-30)
<br />PO Box 1988
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702-1988
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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