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AC40 D® CERTIFICATE OF LIABILITY INSURANCE
<br />DIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />12/TE(MMU
<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 />CONTACT
<br />NAME:PHONE
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />.415-536-8617 F"X .415-536-8627
<br />E-MAILEat)
<br />1255 Battery Street, Suite 450
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC #
<br />San Francisco CA 94111
<br />INSURER A: Berkshire Hathaway Homestate Insura
<br />20044
<br />INSURED CSGCONS-01
<br />INSURERB:Arch Insurance Company
<br />11150
<br />INSURERC:American Fire and Casualty Company
<br />24066
<br />CSG Consultants, Inc., Precision Inspection
<br />550 Pilgrim Drive
<br />Foster City, CA 94404
<br />INSURER D :
<br />PERSONAL &ADV INJURY $1,000,000
<br />INSURER E:
<br />INSURER F :
<br />®
<br />COVERAGES CERTIFICATE NUMBER: 335668352 REVISION NUMRFR-
<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 />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDA`YYY
<br />POLICY EXP
<br />MM/DDIY1'YY
<br />LIMITS
<br />C
<br />X COMMERCIAL GENERAL LIABILITY
<br />BKA1656382766
<br />12/4/2015
<br />12/4/2016
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE IT OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $500,000
<br />MED EXP (Any one person) $5,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />SENT AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />GENERAL AGGREGATE $2,000,000
<br />POLICY ❑ ECT N LOC
<br />PRODUCTS - COMP/OP AGO $2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />BAA1656382766
<br />12/4/2015
<br />12/4/2016
<br />Ea ILMNLaccident)MT $1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANYAUTO
<br />AUTOWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS NOWOWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />USA1656382766
<br />12/4/2015
<br />12/4/2016
<br />EACH OCCURRENCE $5,000,000
<br />AGGREGATE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />CSWC608754
<br />12/4/2015
<br />12/4/2016PER
<br />DTH -
<br />X` STATUTE ER
<br />E. L. EACH ACCIDENT $1,000,000
<br />ANY
<br />OFFICERIMEMBMR EXCLUDED? ECUTIVE
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liablllty
<br />PAAEP0008800
<br />12/4/2015
<br />12/4/2016
<br />Each Claim $3,000,000
<br />retrocede: 1/1/1991
<br />Aggregate $3,000,000
<br />Deductible: $50,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is read Intl)
<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 />j--I'.,,,}���
<br />�t
<br />Santa Ana CA 92702-1988 USA
<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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