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CERTIFICATE OF LIABILITY INSURANCE
<br />E (MM/ DD/YYYY)
<br />DATE
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />1255 Battery Street, Suite 450
<br />CONTACT
<br />NAME:
<br />PHONE FAx
<br />A/C No Ext: 415-536-8617 A/C No): 415-536-8627
<br />ADODRESS: certrequests@ajg.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />San Francisco CA 94111
<br />INSURERA: American Fire and Casualty Company
<br />24066
<br />12/4/2018
<br />INSURED CSGCONS-01
<br />CSG Consultants, Inc.
<br />550 Pilgrim Drive
<br />INSURER B: Arch Insurance Company
<br />11150
<br />INSURER C: West American Insurance Company
<br />44393
<br />INSURER D: Berkshire Hathaway Homestate Insurance Company
<br />20044
<br />Foster City, CA 94404
<br />INSURER E :
<br />INSURER F:
<br />$ 500,000
<br />COVERAGES CERTIFICATE NUMBER: 937596262 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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />BKW57695795
<br />12/4/2018
<br />12/4/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />PREMISES DAMAGE TO
<br />PREMISES Ea occurrence)
<br />ccurrence
<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 � LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />No Ded
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />BAA57695795
<br />12/4/2018
<br />12/4/2019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />No Ded
<br />$
<br />A
<br />X
<br />UMBRELLA LAB
<br />X
<br />OCCUR
<br />USA57695795
<br />12/4/2018
<br />12/4/2019
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ n
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />CSWC929198
<br />12/4/2018
<br />12/4/2019
<br />X STATUTE ER
<br />No Ded
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? N I
<br />NIA
<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 />B
<br />Professional Liability
<br />PAAEP0008803
<br />12/4/2018
<br />12/4/2019
<br />Each Claim
<br />$5,000,000
<br />retro date: 1/1/1991
<br />Aggregate
<br />$5,000,000
<br />Deductible:
<br />$50,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />re: consultant agreement for municipal plan check services made and entered 11/15/16. City of Santa Ana, a charter city and municipal corporation organized
<br />and existing under the Constitution and laws of the State of California, its officers, employees, agents, volunteers and representatives are included as additional
<br />insureds on a Primary & Non -Contributory basis on GL & Auto with 30 Day Notice of Cancellation per attached. 30 Day Notice of Cancellation on Professional
<br />per attached. 30 Day Notice of Cancellation on WC is not available.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) 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 />Santa Ana CA 92702-1988
<br />USA
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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