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CHAMB-4 OP ID: W2
<br />,4`coRca► CERTIFICATE OF LIABILITY INSURANCE706/02/2016(MMIDDIYYYY)TE
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<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(ies) 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 />Kaercher Campbell & Associates
<br />1800 Century Park East #400
<br />Los Angeles, CA 90067
<br />Wendi Carpenter
<br />CONTACT
<br />PHONE FAX
<br />A/c No Ext : IA/C, No
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />X
<br />INSURER A: Liberty Surplus Insurance Corp
<br />06/01/2016
<br />INSURED Chambers Group Inc.-
<br />INSURER B: Commerce & Industry Ins Co 19410
<br />5 Hutton Centre Drive, Ste 750 1
<br />Santa Ana, CA 92707
<br />INSURER C:
<br />INSURER D:
<br />INSURER E
<br />INSURER F:
<br />PERSONAL & ADV INJURY_ $ 1,000,000
<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 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 />DD-LLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X '.. COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />UVEDE104595116
<br />06/01/2016
<br />06/01/2017
<br />EACH OCCURRENCE_ $ 1,000,000
<br />PREM SES Ea occurrence $ 100,000
<br />MED EXP (Any one person) $ 10,000
<br />X '.. Pollution $2mil
<br />(
<br />PERSONAL & ADV INJURY_ $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />X Deductible $2,500
<br />PRODUCTS - COMP/OP AGG ( $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY _X...I PRO- LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />_(Ea accident) $
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />!
<br />! i
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />PER ACCIDENT
<br />$
<br />X UMBRELLA LIABX
<br />OCCUR
<br />EACH OCCURRENCE $ 10,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />UMEDE104596116
<br />06/01/2016
<br />06/01/2017
<br />AGGREGATE $ 10,000,000
<br />DED RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />I
<br />N / A 1,I
<br />!
<br />!i,
<br />WC065257206
<br />05/12/2016
<br />05/12/2017
<br />X WC STATU- ;OTH-
<br />TORY_LIMITS ER
<br />__
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Professional Error
<br />UVEDE104595116
<br />06/01/2016
<br />06/01/2017
<br />Per Claim 1,000,000
<br />& Omissions
<br />RETRO DATE - 1/1/1978
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702;
<br />its officers, employees, agents, volunteers and representatives are named as
<br />additional insureds ("additional insureds") 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 />. f r ....._.. . _- ..
<br />REVIEWED _B /Y-_. �� f ELJN' E- HE REDE A -
<br />....:Iit3 � of
<br />City of Santa Ana
<br />Public Works Agency
<br />20 Civic Plaza M-36
<br />P.O. Box 1988 M-36'
<br />Santa Ana, CA 92702
<br />UANGtLLA I JUN
<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 />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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