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2015/08/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceACORD. CERTIFICATE OF LIABILITY INSURANCE F508 ATE D03/212016YI 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., SUIT�I�V of Kenifee WESTLAKE VILLAGE, CA 91362 INSURERS AFFORDING COVERAGE NAIC# INSURED BURKE, DMINIWILLITR & SORENSEE. AOP; 1 2016 ATTN: ADMINISTRATIVE OFFICE 444 S. FLOWER ST., SUITE 2400 LOS ANGELES, CA 90071@e.ived INSURER A: TWIN CITY FIRE INS CO (HARTFORD 29459 INSURER B: TRUMBULL INS CO (HARTFORD GROUP) 27120 INSURER c: HARTFORD CASUALTY INS CO 29424 INSURER D: HARTFORD INS CO OF THE MIDWEST 20605 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR DATE (MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMI ES (ERENTED rente) $ 300,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE �X OCCUR 72 UUN UR 4713 * HARTFORD FORM 8/1/2015 8/1/2016 MED EXP (Anyoneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X ADD'L INSUREDS * HG0001 INCLUDES BLANKET ADD'L INSURED X WAIVER OF SUBRO * GENERAL AGGREGATE $ 2,000,000 /SUBROPROVISIONS AS GENT AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 X POLICY JEa LOC REQ'D XXXXXXXXXXXXXX B AUTOMOBILE LIABILITY ANY AUTO 72UUNUR4713 ISO FORM CA 0001 8/1/2015 8/1/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1000000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS NOTE: NO OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG C EXCESS/UMBRELLA LIABILITY X OCCUR DCLAIMS MADE 72XHU UR 1585 8/1/2015 8/1/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ RDEDUCTIBLE X RETENTION $ 10,000 $ D WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? If yes, describe under SPECIAL PROVISIONS below 72 WE ZH3458 BLANKET WAIVER OF SUBROGATION 4/1/2016 4/1/2017 X ORYLIMI S OER EL EACH ACCIDENT $ 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 ENDORSEMENT/SPECIAL PROVISIONS THIS CERTIFICATE IS ISSUED TO UPDATE THE WORKERS COMPENSATION POLICY EFFECTIVE APRIL 1, 2016. THIS CERTFICATE FURTHER CERTIFIES THAT THE ALL POLICIES LISTED CONTINUE IN FORCE AS PREVIOUSLY DOCUMENTED. * HARTFORD'S FORM HG0001 INCLUDES EXTENSIONS OF PROTECTION TYPICALLY REQUIRED BY MUNICIPALITIES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 1(OY X MAIL 30 DAYS WRITTEN CITY OF MENIFEE ATTN: CITY ADMINISTRATOR 29714 HAUN RD. MENIFEE, CA 92586 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XXXAi1i�JKM;6K&1(9wX) IK1XotxxxmxKmxxxIiif xxv4ifcXWQ )1VO)QXW(MVEAX-AAXMX*XXX AUTHORIZED REPRESENTATIVE Joh4lk/3eMy, CPCu, ARM ACORD 25 (2001/08) © ACORD CORPORATION 1988