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2014/08/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceACORP., CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE DATE PRODUCER Serial # 100418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU INSURANCE SERVICES / STANTON & ASSOCIATES CA LICENSE OB50569 T: 805.495.6999 F: 805.379.4196 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3625 THOUSAND OAKS BLVD., SUITE 319 WESTLAKE VILLAGE, CA 91362 INSURERS AFFORDING COVERAGE NAIC# INSURED BURKE, WILLIAMS & SORENSEN, LLP ' e ATTN: ADMINISTRATIVE OFFICE �•A� ( M 444 S. FLOWER ST., SUITE 2400 V INSURER A: HARTFORD FIRE INSURANCE COMPANY INSURER B: SENTINEL INSURANCE CO LTD (HARTFORD INSURER C: TRAVELERS PROPERTY & CASUALTY CO LOS ANGELES, CA 90071 INSURER D: INSURER E: COVERAGES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L ADD'L N R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M /DD Y POLICY EXPIRATION DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 72 UUN UR 4713 FORM HG 0001 0605 8/1/2014 8/1/2015 PREMISES OE.occurence S 300,000 MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X ADD'L INSUREDS X WAIVER OF SUBRO GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: (SEE NOTE 1 BELOW) PRODUCTS - COMP/OPAGG S 2,000,000 X POLICY JE LOC XXXXXXXXXXXXXX B AUTOMOBILE LIABILITY ANY AUTO 72 UUN UR4713 ISO FORM CA 0001 8/1/2014 8/1/2015 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S X HIRED AUTOS X NON -OWNED AUTOS NOTE: NO OWNED AUTOS PROPERTY DAMAGE (Per accident) S F1 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE 72 XHU UR 1585 8/1/2014 8/1/2015 EACH OCCURRENCE S 1 ,000,000 AGGREGATE $ 1,000,000 S $ DEDUCTIBLE X RETENTION $ 10,000 $ C WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below IJUB-6627X65-5-15 INCLUDES BLANKET WAIVER OF SUBROGATION 4/1/2015 4/1/2016 TAT X WCRSLIMIT OTH- T Y LIMITS HER EL EACH ACCIDENT S 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS NOTE (1) GENERAL LIABILITY POLICY EXCLUDES PROFESSIONAL SERVICES NOTWITHSTANDING THE EXCLUSION NOTED, BURKE CLIENTS WITH WRITTEN CONTRACTS REQUIRING ADDITIONAL INSURED STATUS ARE RECOGNIZED IN HARTFORD'S COMMERCIAL GENERAL LIABILITY POLICY FORM HG 0001 0605, WHICH ALSO PROVIDES FOR PRIMARY / NON-CONTRIBUTORY INSURANCE, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACTS. COPIES OF FORMS ARE READILY AVAILABLE BY EMAIL. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF MENIFEE ATTN: CITY ADMINISTRATOR 29714 HAUN RD. DATE THEREOF, THE ISSUING INSURER WILLX)Mc X"X MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,x1uiT���c4xiIXXX >Xa➢(d�S?Q�Ct>D�?6)Q�4�CIxr%I1SdNXi�iQrKD(tXiiDf�CCXX MENIFEE, CA 92586 REPRESENTATIVES. UTHORIZED REPRESENTATIVE /S/ JOHN BESSEY, CPCU r ACORD 25 (2001/08) © ACORD CORPORATION 1988