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CHAN13 4 OP ID: W2 <br />CERTIFICATE OF LIABILITY INSURANCE <br />005127120/ YY) <br />05127!8015 <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 statemant on this certificate does not, confer rights to the <br />certificate holder 1n lieu of such endorsemen s . <br />PRODUCER <br />Kaercher Campbell & Associates <br />1800 Century Park East #400 <br />Los Angeles, CA 90067 <br />Wendi Carpenter <br />CONTACT <br />NAME: <br />_ <br />PH o 1: alc, Nol <br />a MAIL <br />ADDRESS: <br />._- <br />(,MOLIC/YYYYI <br />WRDI <br />INSURERSAFEORDiNGCOVERAGE MAIC <br />INSURER A I Liberty Mutual Insurance <br />GENERAL LIABILITY <br />INSURED Chambers Group Inc. <br />ID 725102 <br />5 Hutton Centre Drive, Ste 750- <br />INSURER R: <br />Nsuses D <br />- <br />Santa Ana, CA 92707 <br />INSURER 4: <br />INSURER E: <br />INSURER <br />CCRTRLR'- Tt'd�' <br />PREW ES(Ee occurrence) 3 <br />COVERAGES CERTIFICATE NUMBER: 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 INeJURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 5UBJECT TO ALL THE TERMS, <br />EXOLUBIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />R <br />_ADD[BUSH <br />��TPE! <br />TYPEOF INSURANCE <br />POLICY NUMREPo <br />(,MOLIC/YYYYI <br />WRDI <br />MMI_0,p(YVYY LIMITS <br />GENERAL LIABILITY <br />3 <br />EACH OCCURRENCE S <br />COMMERgAd. GENERAL LIABILITY <br />CCRTRLR'- Tt'd�' <br />PREW ES(Ee occurrence) 3 <br />01 AIMS OCCUR <br />MED EXP(Anyone person) $ <br />PERSONAL E ADV INJURY $ <br />_ <br />m <br />b- <br />GENERAL AGGREGATE <br />GEN'L AGp2EGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG $ <br />POLICY .i" PRD- , LOC <br />_... $ . <br />AV <br />OMOWLE LIABILITY <br />COMUINF-O SINGLE LIMIT <br />Eo na: demi $ ,., <br />ANY AUTO <br />BODILYINJURY(Perpouon) $ <br />ALLOWNED SCHERVLED" <br />AU -103 AUTOS <br />BODILY INJURY {Px ecc'ai -ont} & <br />NON -OWNED <br />PRDPE YDAMAGE$ <br />HIREDAUTOS AUTOS <br />PER ACCIDENT <br />$ <br />UMORELI-A LIAR OCCUR <br />- EACH OCCURRCNCE $ <br />EXCESS LIAa CI.AIASSMAD'c <br />T <br />__— <br />'I AGGREGATE $ <br />— <br />DEQ- I RETENTION,'/, <br />$ <br />WORKERS COMPENDATIONWC <br />STATU- 07H" <br />AND EMPLOYERS' UAOIUTY YIN <br />-QaY <br />ANYQPFICERUICNIC 'CROREXGLINJ02CFi4 ECUTIVE <br />E.L, EACH ACCIDENT $ <br />❑ <br />NJA <br />_ <br />{Mandatary St NH) <br />FL, DISEASE -EA EMPLOYEE $ <br />R yye0. aedp6w under <br />_. _ . _..� <br />DE6CR{PTI NOF OPERATIONS below <br />E,L. DISEASE LIMIT $ <br />A <br />Professional Error <br />_ <br />UVEDE104695116 <br />06/01/2015 <br />06/01/2016 Per Claim 2,000,00 <br />&.Omissions <br />RETRO DATE -1/111978 <br />Aggregate 2,000,00 <br />DESCRIPTION OF OPERATION& t LOCATIONS t VEHICLES {Attach ACORD tOt, Adtlitianal RemarkJJs//Schetlule, it more space is requketl} <br />,f <br />CHAMBERS GROUP A-2013-667-02 REVIEWED BY: y r f _ EUN3CE HEREQIA (PC 2 OF 5) <br />City of Santa Ana <br />Public Works Agency M36 <br />20 Civic Plaza <br />Santa Ana, CA 82702 <br />ACORD 25 (2010105) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />)a 6-< /-&- <br />@ 1988-2010 <br />&- <br />©1988-2010 ACORD CORPORATION.. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />