Loading...
2014/04/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceATE ACORD, CERTIFICATE OF LIABILITY INSURANCE 1 D07/23/2014 PRODUCER Serial # 100418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU INSURANCE SERVICES / STANTON & ASSOCIATES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA LICENSE OB50569 T: 805.495.6999 F: 805.379.4196 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3625 THOUSAND OAKS BLVD., SUITE 319 WESTLAKE VILLAGE, CA 91362 ss', r3 ) � � i �! � �1 INSURERS AFFORDING COVERAGE NAIC# INSURED BURKE, WILLIAMS & SORENSEN, LLJL 2 8 20% ATTN: ADMINISTRATIVE OFFICE 444 S. FLOWER ST., SUITE 2400 LOS ANGELES, CA 90071 INSURER A: HARTFORD FIRE INSURANCE COMPANY INSURER B: SENTINEL INSURANCE CO LTD (HARTFORD INSURER c: TRAVELERS PROPERTY & CASUALTY CO 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDINYYI POLICY EXPIRATION DATE (MMIDDIYYi LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE � OCCUR X ADD'L INSUREDS 72 UUN UR 4713 FORM HG 0001 0605 (SEE NOTE 1 BELOW) 8/1/2014 8/1/2015 EACH OCCURRENCE $ 1,000,000 PREMISES RENTED nce $ 300,000 MED EXP (Anyoneperson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X WAIVER OF SUBRO GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY 71PE LOC PRODUCTS - COMP/OPAGG $ 2,000,000 XXXXXXXXXXXXXX B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS 72 UUN UR 4713 ISO FORM CA 0001 NOTE: NO OWNED AUTOS 8/1/2014 8/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ B EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,000 72 XHU UR 1585 8/1/2014 8/1/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ C WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below IJUB-6627X65-5-14 INCLUDES BLANKET WAIVER OF SUBROGATION 4/1/2014 4/1/2015 STATU- TORY LIMITOT- X WC LIMITS R EH EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE -POLICY LIMIT $ 1,07 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL 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 CITY OF MENIFEE ATTN: CITY ADMINISTRATOR 29714 HAUN RD. MENIFEE, CA 92586 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILLi0fi)0(1i"X MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XXXXX00k)M9XikXXXX D6 aCIXe�ACIXdIS'�QtX�Q�Q i��Cd(�CXX REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /S/ JOHN BESSEY, CPCU ACORD 25 (2001108) © ACORD CORPORATION 1988