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HomeMy WebLinkAboutCHAMBERS GROUP, INC. 2AC 2CFJ� City of Santa Ana Clerk of the Council COTC Office Use Only ------------------------ - - ---- -- --- - ................. . . . .. . .................... ........ AGREEMENT TERMINATION FORM ni-A Please complete this form when the attached agreement and all Q �k N amendments (if any) are no longer in effect. ciTY Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. /I —�/3 (List all amendments. Revised 10.31-12 zcompleted on Use space below if needed.) /,z - 3 /- 13 and final payment has been made. Department: t 41 Phone/Ext.: v Signature: Date: MAYOR Miguel A. Pulldo MAYOR PRO TEM Sal Tinaiero COUNCILMEMBERS Angelica Amezcua P. David Benevides Michele Martinez Roman Reyna Vincent F. Sarmiento ra CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza M-36 • P.O. Boz 1988 M•36 Santa Ana, California 92702 +nvna.santa-ana.oro -t c X014 February 20, 2014 Chambers Group, Inc. 5 Hutton Center Dr. Suite 750 Santa Ana, California 92707 Re: Environmental Consultant Services Agreement A-2013-007 Pursuant to the Consultant Agreement you entered with the City of Santa Ana on January 7, 2013, Section 5 - "Term", the time period of the agreement is hereby extended from December 31, 2013, until December 31, 2014. The insurance certificates and Additional Insured Endorsement are required to be extended and/or renewed to cover this extension. All other terms and conditions of the original agreement remain unchanged and in full force and effect. If you have any questions in this regard, please feel free to contact my office at 714- 647-5662. Si EDWIN "WILLIAW-GALVEZ Interim Executi a Director Public Works Agency ATTEST: MARIA D. HUIZA CLERK OF THE COUNCIL (? Laura Sheedy Assistant City Attorney SANTA ANA CITY COUNCIL A-2013-007-01 Miguel A. Pulitlo i Sal Tnajero VnceN F, sahhlm* Michele Martinez i Angelica Amezcua P. Davie Bena'des i Roman Reyna Mayor i Mayor f'rII TMT We'd & i WarUt W.,d2 Ward Wartl4 Wartl5 MWlitlo�rzsantaanaone y ierotIDsar+ta-ana.oro i VSarmiento,fi5anta ana ora i MMartinez(olsania-arca wo i AAmezcva,'6',sd!+ -ara. r i DBenau�es�sania-ana ora i Gy.Q@'r�santa-a^.a.vro CHAMB4 OP TD: W2 A�fIL) CERTIFICATE OF LIABILITY INSURANCE DAie IMMIDOM'YYI TYPE OF INSURANCEPOLICYNUMBER 06/2512013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT TE OF INSURANCE BELOW. THIS CERTIFICATE E INSURANCE DOE5 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(lea) must be endorsed. If SUBROGATION I$ WAIVED, subject to the tens and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCER Phone: 310.556-1900 Kaercher Campbell & Associates 1600 Century Park East X400 Pax: 310-656.4702 GarLos y ea, CA 90067 Lutz rY..... ACCORDANCE WITH THE POLICY PROVISIONS. .._ IFyRugRE I' A'�---- No Etll• IMP, Ndl: 16c;�L - INSURERS AFFORDING COVERAGE NAICS OENERALLIABNTY X CAMMFRCIAL GENERAL UA61UIY nXOOCUR INSURER A:Llb Mutual Insurance ___ INSURED ham ers Group Inc. 6 Hutton Centra Drive, ate 760 Santa Ana, CA 92707 INSURER B: 0ranite State Insurance Co. INsuReRC:Commen:e & Indus!!g 19410 INSURER 0: EACH OCCURRENCE 111000,000 INSURER E: MED ESP An one euonJ S 10,000 INSURE CLAIMSAADE COVERAGES CERTIFICATE NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lm TYPE OF INSURANCEPOLICYNUMBER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN POL Y F ACCORDANCE WITH THE POLICY PROVISIONS. LINTS A OENERALLIABNTY X CAMMFRCIAL GENERAL UA61UIY nXOOCUR Santa Ana, CA 62702 UVED2104696113 0610112013 06/0112014 EACH OCCURRENCE 111000,000 PREVETO-REgM M7® 5 100,00 MED ESP An one euonJ S 10,000 CLAIMSAADE PERSONAL, a ADV INJURY S 1,000,00 GENERAL AOGREGATE S 2,000,00 GENL AGGREGATE POLICY LIMIT APPLIES PER. 51 PRO. LOC PRODUCTS-COMM?AGO S 2,000,000 S AUTOMOBILE LIABILITY I NUL —Ll M- aeccMen s BODILY INJURY(PUPeuun) S ANY AUTO ALL OMMEP SCHEOULED AUTOS AUTOS HIREDAUCS NON -OWNED AUTOS -- BODILY INJURY (Per mldoni) S PROPERTYD lPintAcIdenh S A X UMBRELLA LIAO EXCESSLIAB X OCCUR CLAIMS MADE MEDE104596113 06101/2013 0610112014 EACHOCOJRRENCE S 4,000,000 AGGREGATE 1 4,000,000 DED RETENTION 5 B C COMPENSATION AND KERS EMPLOYERS' AND EMPLOYERB'LUIBILITY YIN ANY PROPRIETOINPARTNFRIEXECUI'NE pddMn)ILWEDv ❑tinuy NN Mer II tAeeclBo VF S RIPrI FOPEMTIONS UeIaw NIA COSS267206 - CA COSS297206-NV Otif1212013 0511212013 0511=014 06(12/2014 NC BTATU- TRH X R --- BL EACHACCIOENT S 1,000,00 _ E.L. DISEASE, EA EMPLOYE S 1,000.00 EL DISEASE-POUCY LIMIT S 1,000,00 A Dilution Llability �VEDE`10459611113 08101/2013 0610112014 Aggregate 2,000,00 Deduc 2,50 DESCRPT M OF OPEMTIMS J LOCAMMS I VEHICLES (AtbcA ACOAO IDI, Atltllllonal Ramulu 9cMdule, If mon epee LL repulrotll The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its offioera, employees, agants, volunteers and representatives are named as additional insureds. �-.�� SIA $50,000 Blanket Waiver of Suhrogation applies as required by contract. APp,RO I-' }`v5 ,j- G A K STORCK CERTIFICATE HOLDER r.AMrFi r ATInN 61988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M36 AUTHORIZEOREPRESENTATIVE Santa Ana, CA 62702 � Gig 61988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: UVEDE104595112 COMMERCIAL GENERAL LIABILITY Chambers Group, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, Ca 92702 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Pmjcct Name: TO Assista�'' � t CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1954 ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: Liberty Mutual Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # UVEDE104595113 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 06/01/2013, this endorsement form as a part of Policy # UVFDF104595113 Issued to Chambers Group Inc Named Insured Countersigned by Authorized Representative C, O } OitNi Apt' OVV _ A55iSt�n� �� ® A� �' CERTIFICATE OF LIABILITY INSURANCE DA70'W292013 IMNJDOMYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTiFTE DOES NOT BELOWCATHIS CERTFIICATEPOF INSURANCE DOES NOT IRMATIVELY OR LCONSTTUTEY AMEND, XAECONTRACT BETWEEN N13 OR ALTER THE OTHESSUINGGE FNSURER(S),ORDED BY fPOLICIES REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(las) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsament(s). PRODUCER SC Associates Insurances Services, Inc 2659 TOWNSGATE RD co NAME, PPNONE MAIL INSURER [$) AFFORDING COVERAGE NAN: P STE 102 WESTLAKE VILLAGE CA 91361 INSURERA: DEPOSITORS INSURANCE COMPANY 42587 INSURER 9: INSURED INSURER C: WauNER o : ..... - CHAMBERS GROUP, INC S Ml1TTONCENTRE DRSTE 750 IN URBE l : INs RER F: SANTAANA CA 92707-8720 COVERAGES um— nrlA.r- claim,--- .. ------ INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. N07WHSTANDING ANY REQUIREMENT, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY TYPE OF INSURANCE 20 Civic Center Plaza, M30 P.O. Box 1988 POLICY UMBER WIvvYY UCY EXP MMm UMTS GENERAL LIABILITY CE S--,__,,, MOT= PREMISES Eaoacaneneai S _ CCMMENCIAL GENERA- LABILITY MED EXP (My are person S CLAIMS.MADE E -1I CCCUR � � PERSONAL a AOV INJURY a GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPQPAGG S f M POLICY PRO LOC AUTOMOYILa LIABILITY r (E..cclowlL S t BDD BDB 90gLY tNAIRY tPere..4 SAAViOs ANYAUTOGOWLYINJURY(PorSALLO ED SCHEDULED - oN RULED JX ACP BAPD 2525084678 0610112013 106101/2014 PROPER A ° HIREDAUTOS x AUTOS I i S UMBRELLA LIAe CCCURF�—r EACH OCCURRENCE S AGGREGATE EXCESS LIAR CLAIMS -MADS S OED RETENTIONS OTH- NORRERS COMPENSATION j TORY LI IC EL EACH ACCIDENT 5 ANO EMPLOYERS' UABILUY AHVPENEMB R MUUDERIEXECUTIVE YIN OFFICELrEMaER FJ(CLUDEOT ' EL. DISEASE - EA EMPLOYE S trMaaelaw In Nm It yes, Micnbe unar E.L. DISEASE POLICY LIMIT L I- DESCRIPTIONOFOPERAMMSVACATIONSIVEHICLES OyRecb ACOR0101, Aad11Ma1 Rameme 8aM1e0ule, Ir man spice le mqutr.al The 'Clerk of the City Council" is named as additional insured. However," The City of Santa Ana, its officers, employees, agents and representatives', sho Id be, t the additional insuredTis �avy;r, Certificate holder is listed as designated insured Under form CA2048�..— Waiver of subrogation applies perform CA0444- ORGY` c1:311 lt9cAIC MUL.Urm Clerk Of the City Council SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M30 P.O. Box 1988 AUTHORISED REPRESENTATIVE Santa Ana CA 92702 Nell Churchill Va 1988-ZUIU AGUKU UUKrumm nr/n. xn uynu rexrro... ACORD 26 (2010105} The ACORD name and logo are registered marks of ACORD �'""' ACn eAnn xjt5084e70 COMMERCIAL A UTO AC 24 048 05 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modlfios insurance Provided under the following, BUSINESS AUTO COVERAGE FORM The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — BUSINESS AUTO CONDITIONS) Is amended by the addition of the following: We waive any right of recovery we may have against any person or oiganizalion to the extent required of you by a written oonlracl oxoculed prior to any "accident' because of payments we make for damages under this coverage form. All terms and conditions of this policy apply unless modified by this endorsement. AC 24 048 05 04 Page 7 of 5 APPROVE11 �tiyU ` C� FORM "swAan,. City Aittorney -1/ .1 / C ACP BAPn zstsoeneie COMMERCIAL AUTO CA 20 488 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided underthe following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM This endorsement identifies person(s) or organizatlon(s) who are 'Insureds" under the Vvho Is An Insured Provi- sion of the Coverage Form. This endorsement does not allar coverage provided in the Coverage Form. This endorsement changes the policy effective on the Inception date of the policy unless another date in indicated below. SCHEDULE Name or Person(sj or Organizatlon(s): Any poison or organization which you have agreed to name as an additional insured in a written contract, exe- cuted prior to a loss other than a contract for the lease or rental of a vohiole, Of no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement,) Each person or organization shown in the Schedule is an *Insured" for Liability Coverage. but only to the extent that person or organization qualifies as an "Insured" under the Me Is An Insured Provision contained in Section II of the Coverage Fonn. All terms and conditions of this policy apply unless modified by this endorsement. CA 20 48D 02 99 Copyright, Insurance Services Office, inc,, 1998 Page 1 of 1 M IIY�/�✓-/CoTc CHAMB-4 OP ID: W2 CERTIFICATE OF LIABILITY INSURANCE D0511212DIYq CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Dsn zrzDla THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED; the poltcyjfes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C Campbell 8, Associates 1800 1800 Century tury Park East #400 Los Angeles, CA 90067 Wendt Carpenter CON•ACT NAME: PHONE o me No: E -NI L ADDRESS: _ INSURERS AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURERA: Liberty Mutual Insurance INSURED Chambers Group Inc. 5 Hutton Centre Drive, Ste 750 Santa Ana, CA 92707 INSURERS: Granite State Insurance Co. :NSURERC:Commerce & Industry 19410 INSURER 0: X CDMMERCIAL GENERAL LIABILITY INSURER E: vl INSURER F COVERAGES LICK IIFR:A I C N'IUMBI=R: GCVImOM yr IRMO On THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OFIN$URANCE D ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER MNINYYYY MMlDMYYYY LIMITS GENERAL LIABILITY IMRffUffRF EACH OCCURRENCE $ 1,000,00 A X CDMMERCIAL GENERAL LIABILITY UVEDE104595113 08101/2013 06/01/2014 PREMISES EaoccvrtercaS 100,00 CLAIMS -MADE a OCCUR MED EXP (Any one Poo l S 10,00 PERSONAL& ACV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,0 AS TO 1"y GEN'L AGGREGATE _IMT APPLIES PER: PRODLCTS-COMP/OPAGG $ 2,000,0 Y RO Y POL.'Y X PRO- LOC $ AUTOMOBILE LIABILITY r COMBINED SINGLE LIMIT (ED acbidw ANY AUTO L`Y' BODILY INJURY (Papalson) ALLOWNED SCHEDULED ptorney nt tatty - fi$ BODILY INJURY Par acmdenl) $ .... AUTOS AUTOS HIRED AUTOS NCV-0NINED AUTOS Ae$15ta PROPERTY DAMAGE PER ACCIDENT S 3 X UMBRELLA LIAB X OCCUR EACH 02CURRENCE f$ 4,000,00 A EXCESS UAB CLAIMS -MADE UMEDE104596113 06/01/2013 06101/2014 AGGREGATE S 4,000,00 DED RETENTION $ WORKERS COMPENSATION X WCSTATU- OUR EMPLOYERS' LIABILITY YIN _ EL. EACHACCIDENT S 11000,00 ---. B WC065257206 05112/2014 05/1212015 OFRCERAILMDER EXCLUDED' ;NIA E.L. DISEASE - EA EMPLOYE $ 1,000,00 IANYPRCPRIETCRJPARTNERIEXECUTIVE (Bandana, in NHI dosry ryeeRIPTI EL DISEASE - °GLIDY LIMIT $ 1,000,00 NuMer DE$�RIPTION OF OPERATIONS below A Pollution UVEDE10459BIl 06/01/2013 06/01/2014 Aggregate 2,000,00 Liability Deduc 2,500 DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarlu Schedule, houni space is racclred) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, Employees, agents, volunteers and representatives are named as additional insureds. SIR $50,000 Blanket Waiver of Subrogation applies as required by contract. CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD p J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, M36 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD p J CHAMB-4 OP ID: W2 sa`v�rc� CERTIFICATE OF LIABILITY INSURANCE OA0712412014Y) onzalzola THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DDES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND V. TEP#LVR4 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, c§[tf�gol�5s y rI Ire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorselh${(�. U �� ry�� ANA PRODUCER CLERK, OF rI r11' I Kaercher Campbell & Associates 1800 Century Park East #400 Los Angeles, CA 90067 Wend! Carpenter CONTACT NAME: PHONE x A C No E-MAIL ADDRESS: INSURERIS), AFFORDING COVERAGE NAICk LIMITS INSURER A: Liberty Mutual Insurance GENERAL LIABILITY INSURED Chambers Group Inc. 5 Hutton Centre Drive, Ste 750 INSURER B: Granite State Insurance Co. Santa Ana, CA 92707 INSURER C INNSSURED A IURERR E: X INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBIR POLICY NUMBER POLICY EFF MMIDDryYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIALGENERALLIABILITY CILAIMS-Iri OCCUR X UVEDE104595114 0610112014 06/0112015 PREMISES Ea occurrence $ 100.00 MED EXP (Any one person) $ 10,00 X Polllution$lmilO F PERSONAL& ADV INJURY $ 1,000,00 X Claims Made GENERAL AGGREGATE $ 2,000,00 ♦ �g! o GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 titOv-� ` ,7 POLICY PRO - iECT LOC S AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 3D 1 �y�iat9l><► tC tT9k= AA! i+♦� v Ea accident SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ P RACCIDENT S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,00 AEXCESS LIAR CLAIMS -MADE UMEDE104596114 0610112014 0610112015 AGGREGATE $ 4,000,00 DEO RETENTION$ $ B WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECIJUVE YIN r7 OFFICERIMEMBER EXCLUDED? (Mandalay In NH) Use, describe under DESCRIPTION OF OPERATIONS below C065257206 0511212014 0511212015 4VC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE -EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A Professional Error UVEDE104595114 0610112014 0610112015 Per Claim 2,000,00 & Omissions RETRO DATE - 11111978 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Agency M36 AUTHORIZED REPRESENTATIVE 20 Civic Plaza Santa Ana, CA 92702 ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: Liberty Mutual Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy # UVEDE104595114 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 06/01/2014, this endorsement form as a part of Policy # UVEDE104595114 Issued to Chambers Group, Inc. Named Insured Countersigned by Authorized Representative �1 ACRO- CERTIFICATE OF LIABILITY INSURANCEDATEimwom"""°"4) 1 06/04/2 RODucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY SC ASSOCIATES INC AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 2659 TOWNSGATE RD CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE WESTLAKE VILLAGE, CA 91361 COVERAGE AFFORDED BY THE POLICIES BELOW. CHAMBERS GROUP INC 5 HUTTON CENTRE DRIVE, SUITE. 750 IRVINE, CA 92707-8720 INSURERA: DEPOSITORS INSURANCE INSURER B. INSURER C: INSURER 0 INSURER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR AWL TYPE OFINSIBtANCE POLICY NUMBER POUCYEFFECTIVE EXPIRATION LIMITS LTR MSR AUTHORRED REPRESENTATIVE DATE WDOIYY DATE MWDDIYY ❑ GENERAL LIABILITY EACH OCCURENCE § DAMAGE TO RENTED ❑ COMMERICAL GENERAL LIABILITY DOCLAIMS MADE [I OCCUR PREMISES Ea arcurrerpel $ MED EXP (Any one perms) $ PERSONAL & ADV INJURY $ — Fl GENERAL AGGREGATE $ GEH L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ ❑ POLICY ❑ PROJECT ❑ LOC S A ® U OMOMLTLIABILITY ACPBAPD2535084678 06/01/2014 06/01/2015 COMBINED SINGLE LIMITANYAU $1,000,000 (Each Oavre ❑ ALL OWNED AUTOS BODILY INJURY ❑ SCHEDULED AUTOS (Par parmn) f ® HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Par accltlen9 f ❑ _-___. El PROPERTY DAMAGE (Per arc wt) f ❑ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ❑ANY AUTO n AUTO ONLY AGG S ❑ EICESSIUMBRELLALIABRJTY EACH OCCURRENCE $ AGGREGATE $ ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE $ ❑ RETENTION S_ S Fl WORKERS COMPENSATION AND ❑ ❑O EMPLOYERS' LIABILITY EMPLOYERS' ER EL EACH ACCIDENT _ $ ANY PROPRIETOR/PARTNER/EXECU- TIVE OPFICERIMEMBER EXCLUDED' EL DISEASE - EA EMPLOYEE $ X yes, tlesuibe urMer SPECIAL PROVISIONS below EL DISEASE -POLICY LIMIT — - $ -Er DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS AN ADDITONAL INSURED, PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES. WAIVER OF SUBROGATION IS INCLUDED, 30 DAY NOTICE OF CANCELLATION/ 10 DAY NO"1"ICE FOR NON-PAYMENT CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) (D ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO 20 CIVIC PLAZA MAIL R DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT SANTA ANA, CA 92702 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORRED REPRESENTATIVE ACORD 25 (2001/08) (D ACORD CORPORATION 1988 CA 20 46 (0249) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. o CILI I C, 4 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FCRM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement Identifies person(s) or organization(s) who are "insureds' under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name of Peraon(s) or Orgenlsetion(s): CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 (If no entry appears above, Information required to complete this endorsement will be shown In the Declarations as applicable to the endorsement.) Each person or organization shown In the Schedule is an "Insured' for Liability Coverage, but only to the extent that person or organization qualities as an 'Insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 e6 (02-99) Copyright, Insurance Services Office, Inc., 1986 LYND 14121 AGEW COPY CA20490M 0 0240 25 0010550 COMMERCIAL AUTO CA 04 44 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the fallowing: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name(s) Of Person(s) Or Organizatlon(a): CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. All terms and conditions of this policy apply unless modified by this endorsement. CA 04 44 0310 ® Insurance Services Office, Inc., 2009 Page 1 of 1 ACP BAPD25-35084070 LYND 14121 AGENT COPY CA0441031000 0200 25 0000345 COMMERCIAL AUTO AC 20 41 07 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): CITY OF SANTA ANA PUBLIC WORKS AGENCY M36 (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to the endorsement.) A. SECTION II- LIABILITY COVERAGE Who Is An Insured is amended to include as an additional Insured for Liability Coverage: Each person or organization shown in the Schedule, but only to the extent that person or organization qualifies as an "insured". Loss must arise out of ongoing operations performed for the Named Insured. B. SECTION IV- BUSINESS AUTO CONDITIONS SECTION V- GARAGE CONDITIONS The following paragraph is added to B.5 of Other Insurance: e. If required by a written contract or written agreement executed before the "accident" occurred, any insurance carried by the per- son or organization shown in the schedule shall be noncontributory with respect to the coverage provided to you. All terms and conditions of this policy apply unless modified by this endorsement. AC 20 41 07 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission