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CHAMS-4 OP ID: V12
<br />AC --"(4 LY
<br />... " CERTIFICATE OF LIABILITY INSURANCE
<br />v
<br />GATE (MMIDnrVYYY}
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF. 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 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 endorsements).
<br />PRODUCER CONTACT
<br />NAME:
<br />Kaercher Campbell &Associates PAX
<br />PHONEg,Sxti"
<br />1 BOO Century Park rest 9400 I LA
<br />'—
<br />Los Angles, CA 90067 E-MAIL
<br />WendiCarpenter AceREss: _
<br />INSURERS AFFORDING COVERAGE _ NAiCa
<br />INSURER A: Liberty Mutual insurance
<br />INSURED Chambers Group Inc. INSURER e: Commerce & Industry 19410
<br />6 Hutton Centre Drive, Ste 750
<br />INSURER C
<br />Santa Ana, CA 92707
<br />INSURER 0: _
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: RFvIRION NIIMFUrp.
<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 01 HER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF. 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 />R _ TYPED, INSURANCE
<br />ACCORDANCE WITH THE POLICY PROVISIONS..
<br />P LCY P,L`_
<br />POUCY NUMBER fN OD Y
<br />_PS - _.._
<br />YYYY) LORTa
<br />GENERAL. UABIUTY
<br />20 Civic Plaza
<br />Santa Ana, CA 92702;,`-
<br />EACH OCCURRENCE S 1,000,00
<br />A X COMMERCIAL GENERAL LIABILITY
<br />X
<br />UVEDE104695115 0610112019
<br />0610112010 NITRUf PREMISES Ea ITTED $ 10000
<br />�.�_.
<br />GLAIMS^MADE � OCCUR
<br />MED EXP(Aly oas etson} $ 10,00
<br />X Pollution,$lmtl
<br />PERSONAL &ADV MJURY $ 1,000,00
<br />X DedLlCtlbe1$2,500
<br />GENERALAGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS -COONCE AGO $ 2,000,000
<br />p01.ICY
<br />X PRG" � LOC
<br />$
<br />AUTOMOOILC
<br />LIABILITY
<br />_
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />ANY A111'0
<br />BODILY INJURY (Par person) $
<br />ALL OWNED SCHEDULED-
<br />AUTOS AUTOS
<br />BODILY INJURY(Peraccidri $
<br />NON -OWNED
<br />HIRED AUTOS
<br />._....
<br />P OPERTV DAMAGE $
<br />AUTOS
<br />� PFR ACCIDENT)
<br />I
<br />$
<br />X UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCGVRREN=E 3� 4,000,000
<br />A ExcEss UA9
<br />CtAIMS-MADE
<br />UMEDE104896115 06101/2016
<br />0610112016 AGGREGATE 54,000,00
<br />$ ............_
<br />DED1 ..............1_RETENTION$
<br />WORKERS COMPENSATION
<br />WC STATU- OTN-
<br />X
<br />AND EMPLOYCRVLiASiLiTY YIN
<br />„�,, ,,
<br />B ANY PROPRIETCRPARTNERIEXECUTIVE
<br />VVC065267206 0511212019
<br />0611212016 ESL EACHACCIDENT s 1,000,00
<br />OEFICER/MCMaER EXCLUDED?
<br />NIA
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If gyas deserbe undo,'
<br />DUST l P@RATIONS below
<br />.......--^_.-�
<br />EA. DISEASE - POLICY LIMIT $ 1,000,000
<br />A Professional Error
<br />UVEDE1045DS114 06/0112016
<br />_
<br />06/0112016 Per Claim 1,000,000
<br />& Omissions
<br />RETRO DATE - 111/1978
<br />Aggregate 2,000,000
<br />DESCRIPTION ON OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 1 d1, AddRienai Romarks Schu, Wa, If mora space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 927011
<br />its officers, employees, agents, volunteers and representatives are named as
<br />additional insureds ("additional insuxeds") 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 />CHAMBERS GROUP A-2013-007-02 REVIEWED BY: fls - d/ " d r EUNICE HEREDIA (PG 3 OF 5)
<br />CERTIFICATE HOLDER CANCELLATION
<br />0 1988.2090 ACORD CORPORATION. All rights reserved,
<br />ACORD 26 (20101061 The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF ]'HE 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 />----
<br />AUTHORIZED REPRESENTATIVEY
<br />20 Civic Plaza
<br />Santa Ana, CA 92702;,`-
<br />lr
<br />0 1988.2090 ACORD CORPORATION. All rights reserved,
<br />ACORD 26 (20101061 The ACORD name and logo are registered marks of ACORD
<br />
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