2019/08/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceACC) DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 7i30i2019
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 policy(ies) 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 129ffAOTKaSey LitZ
ISU Stanton & Associates
Stanton & Associates
3625 Thousand Oaks Blvd #319
Westlake village CA 91362
INSURED
Burke, Williams & Sorensen, LLP
444 S. Flower St., Suite 2400
a):(805)413-1498
kassy@isustanton.com
INSURER A:Hart ford Fire Insurance
INSURER B :Trumbull ins. Co.
INSURER E .
LOS Angeles CA 90071 1INSURER F:
COVERAGES CERTIFICATE NUMRFR-19-20 City REVISION NUMRER-
(805)435-3737
27120
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 ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER M DIYYYY LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE x OCCUR
A MAGE R
PREMISES Ea ccurren
$ 300, 000
MED EXP (Any one person)
$ 10,000
X
72UUNUR4713 8/1/2019
8/1/2020
PERSONAL & ADV INJURY
$ 1,000,000
GENLAGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY C JECT LOC
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
Ea M&'' NIN L M
ci e
$ 1,000,000
BODILY INJURY (Per person)
$
B
ANY AUTO
ALL OWNED I SCHEDULED
AUTOS AUTOS
72UUNOR4713
8/1/2019
8/1/2020
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per vcciderrt
I$
NON -OWNED
HIRED AUTOS . X , AUTOS
Is
X
UMBRELLA LIAB I X : OCCUR
.
EACH OCCURRENCE
$ 10, 000, 000
AGGREGATE
$
C
EXCESS LIAB I CLAIMS -MADE
DED 1 X I RETENTION$ 10,000
$
727Di=4585
8/1/2019
8/1/2020
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE i
OFFICER/MEMBER EXCLUDED? 71
(Mandatory in NH)
N / A
72WEAB2915
8/1/2019
8/1/2020
X I PER
STATUTE Fit
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Hartford CGL policy form HG0001 includes Additional Insured status, Primary and Non -Contributory wording,
and Waiver of Subrogation where required by written contracts."
CG2026 -Additional Insured - Designated Person or Organization
IH0313 - 30-Day Notice of Cancellation to Designated Certificate Holders
WC040306 - WC Waiver of Subrogation
CERTIFICATE HOLDER ".Y►r ni till alee., r-ANCFI I ❑TInm
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Menifee
Attn: City Administrator
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Rd
AUTHORIZED REPRESENTATIVE
Menifee, CA 92586
Kasey Litz/KASEY
U 1938-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 72 UUN UR4713
COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following;
COMMERCIAL. GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organzzation(s):
any person or organization from whom you are required by written contract
for agreement to obtain Additional Insured status.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section Il — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury', "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured will
not be broader than that which you are required
by the contract or agreement to provide for such
additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 72 WE AB2915 Endorsement Number:
Effective Date: 08/01/19 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: BURKE, WILLIAMS & SORENSEN LLP
444 S FLOWER ST STE 2400
LOS ANGELES CA 90071
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due
on such remuneration.
SCHEDULE
Person or Organization
Job Description
Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights
from us
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 07/29/19 Policy Expiration Date: 08/01/20
Ln
IV
N
0
0
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
This policy is subject to the following additional
Conditions:
A. If this policy is cance#led by the Company, other
than for nonpayment of premium, notice of such
cancellation will be provided at least thirty (30)
days in advance of the cancellation effective bate
to the certificate holder(s) with mailing addresses
on file with the agent of record or the Company.
B. If this policy is cancelled by the Company for
nonpayment of premium, or by the insured, notice
of such cancellation will be provided within (10)
days of the cancellation effective date to the
certificate holder(s) with mailing addresses on file
with the agent of record or the Company.
Form lit 0313 06 11
If notice is mailed, proof of mailing to the last known
mailing address of the certificate holder(s) on file with
the agent of record or the Company will be sufficient
proof of notice.
Any notification rights provided by this endorsement
apply only to active certificate holder(s) who were
issued a certificate of insurance applicable to this
policy's term.
Failure to provide such notice to the certificate
holder(s) will not amend or extend the date the
cancellation becomes effective, nor will it negate
cancellation of the policy. Failure to send notice shall
impose no liability of any kind upon the Company or its
agents or representatives.
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0 2011, The Hartford