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2016/04/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceACORP. CERTIFICATE OF LIABILITY INSURANCE F508 1 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 BURKINSURER TTN: DMINIWILLITR & SORENSEE LLP ATTN: ADMINISTRATIVE OFFICE 444 S. FLOWER ST., SUITE 2400 A: TWIN CITY FIRE INS CO (HARTFORD GRP) - 29459 INSURER B: TRUMBULL INS CO (HARTFORD GRP) - 27120 27120 INSURER C: HARTFORD CASUALTY INS CO - 29424 29424 INSURER D: HARTFORD INS CO OF THE MIDWEST - 20605 LOS ANGELES, CA 90071 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 J.IEADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDDfYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A MERCIALGENERAL LIABILITY CLAIMS MADE FED OCCUR kXADD'L 72 UUN UR 4713 " HARTFORD FORM 8/1/2016 8/1/2017 PREMDAMAISESOEaoccEDence s 300,000 MED EXP (Anyone person) S 10,000 INSURED H00001 INCLUDES BLANKET ADD'L INSURED PERSONAL&ADVINJURY S 1,000,000 IVER OF SUBRO * GENERAL AGGREGATE S 2,000,000 GEN'LA GGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC /SUBRO PROVISIONS AS REQ'D PRODUCTS - COMP/OPAGG $ 2,000,000 XXXXXXXXXXXXX B AUTOMOBILE LIABILITY ANY AUTO 72 UUN UR4713 ISO FORM CA 0001 8/1/2016 8/1/2017 COMBINED SINGLE LIMIT (Ea accident) g 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS NOTE: NO OWNED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG C EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE 72XHU UR 1585 8/1/2016 8/1/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 S $ DEDUCTIBLE X RETENTION S 10,000 $ D WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 72WEZH3458 BLANKET WAIVER OF SUBROGATION 4/1/2016 4/1/2017 X ITOCYTA S OR EL EACHLIMITSACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE S 1,000,000 EL DISEASE - POLICY LIMIT S 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *A NOTE ABOUT HARTFORD'S CGL POLICY FORM HG0001: BURKE CLIENTS WITH WRITTEN CONTRACTS REQUIRING ADDITIONAL INSURED STATUS ARE INCLUDED UNDER HARTFORD'S COMMERCIAL GENERAL LIABILITY FORM HG0001. THE HG0001 FORM ALSO INCLUDES PRIMARY / NON-CONTRIBUTORY PROVISIONS, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION. A PDF OF THIS 18-PAGE POLICY FORM IS 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 DATE THEREOF, THE ISSUING INSURER WILL X1i"X MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AX�99AiYXI[�XX 29714 HAUN RD. xdx(xx Qti%IxIZL`6KTXox�QxIii�xxlV)Ofci(t�JQSiiI�'t�1�'OlG}(bK6(b?txxfxxxx`I�ixx*xXX MENIFEE, CA 92586 REPRESENTATIVES.AUTHORIZED REPRESENTATIVE JOhYL 3e4 y, CPCU, ARM 4CORD 25 (2001108) © ACORD CORPORATION 1988