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A� vv® CERTIFICATE OF LIABILITY INSURANCE
<br />21112016 DATE (M UDmrvl
<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) INOTt OONSTFTUTE,A,CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFfCAYEIHOL6E11.
<br />IMPORTANT: If the certificate holder is an ADDITIO A INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain poll ay'recjulre Pd anAcirsementf A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). r
<br />PRODUCER 'ICONTACT..
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />1255 Battery Street, Suite 450
<br />NAME:
<br />PH °NE 415- 536 -8617 F Nel. 415- 536 -8627
<br />E -MAIL
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />San Francisco CA 94111
<br />INSURERA:Arch Insurance Company
<br />11150
<br />BKA1656382766
<br />INSURED CSGCONS -01
<br />INSURERB:American Fire and Casualty Company
<br />24066
<br />CSG Consultants, Inc.
<br />INSURER c:CYPRESS INS CO
<br />10855
<br />550 Pilgrim Drive
<br />Foster City, CA 94404
<br />INSURER D:
<br />INSURER E:
<br />$500,000
<br />NS URER F
<br />MED EXP(Any one person)
<br />$5,000
<br />COVERAGES CERTIFICATE NUMBER: 1990916607 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 />rypE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY )
<br />POLICY EXP
<br />(MMIDD,YYYYJ
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />BKA1656382766
<br />12/4/2015
<br />1214/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE X OCCUR
<br />❑
<br />DAMAGES( RENTED
<br />PREMISES RENT rrence )
<br />$500,000
<br />MED EXP(Any one person)
<br />$5,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />POLICY ] PRO-
<br />JECT [X] LOC
<br />PRODUCTS - COMPIOP AGO
<br />$2,000,000
<br />_
<br />$
<br />OTHER'.
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />13AA1656382766
<br />12/412015
<br />1214/2016
<br />MBINED IN LE LIMIT
<br />Eeaccident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accitlent
<br />( )
<br />$
<br />_
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />PerecGdent
<br />$
<br />_
<br />$
<br />B
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />USA1656382766
<br />12/4/2015
<br />1214/2016
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY YIN
<br />CSVVC607956
<br />1214/2015
<br />12/4/2016
<br />X PER OTH-
<br />STATUTE ER
<br />OIFFICER/MEMBEER EXCW OED9 ECUTIVE M
<br />NIA
<br />EL EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />A
<br />Professional Liability
<br />PAAEP0008800
<br />1214/2015
<br />12/4/2016
<br />Each Claim $3,000,000
<br />relrodate, 1/1/1991
<br />Aggregate $3,000,000
<br />Deductible: $50,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be ads abed if more space is require0l
<br />re: consultant agreement for municipal plan check services. 30 Day Notice of Cancellation on Professional Liability per attached. 30 Day
<br />Notice of Cancellation on Workers Comp is not available.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988.2014 ACORD CORPORATIO / II rights r served.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AkppgA)vll ��
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE `l. �%�%�•^�--���C2
<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 />�rr1
<br />Santa Ana CA 92702 -1988 USA
<br />©1988.2014 ACORD CORPORATIO / II rights r served.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AkppgA)vll ��
<br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE `l. �%�%�•^�--���C2
<br />
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