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2017/08/01 Burke, Williams & Sorensen, LLP Certificate of Liability InsuranceAC®R® CERTIFICATE OF LIABILITY INSURANCE F508 D07/25/2017 na PRODUCER Serial # 100418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISU / STANTON & ASSOCIATES CA LIC # OB50569 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ATTN: JOHN BESSEY JOHN(a�ISUSTANTON.COM 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 A: TWIN CITY FIRE INS CO (HARTFORD GRP) - 29459 BURKINSURER & SORENSCEEN, LLP INSURER B: TRUMBULL INS CO (HARTFORD GRP) - 27120 27120 ATTN: DMINIWILLIT ATTN. ADMINISTRATIVE OFFICE INSURER c: HARTFORD CASUALTY INS CO - 29424 29424 444 S. FLOWER ST., SUITE 2400 INSURER D: 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 L ADUNSR TYPE OF INSURANCE POLICY NUMBER POLICE EFFE CTIVE POLT Y EXPIRADr M/oDfTION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 72 UUN UR 4713 8/1/2017 8/1/2018 DAMAGE TOPREMISES E NTEDrence $ 300,000 CLAIMS MADE FX I OCCUR * HARTFORD FORM MED EXP (Anyoneperson) $ 10,000 X ADD'L INSURED * HG0001 INCLUDES PERSONAL & ADV INJURY $ 1,000,000 X WAIVER OF SUBRO BLANKET ADD'L INSURED GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 /SUBROPROVISIONS AS X I POLICY JE� LOC REQ'D XXXXXXXXXXXXXX AUTOMOBILE LIABILITY 72 UUN UR 4713 8/1/2017 8/1/2018 COMBINED SINGLE LIMB $ 1,000,000 B ANY AUTO ISO FORM CA 0001 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS NOTE: NO OWNED X NON -OWNED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ RANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY 72 XHU UR 1585 8/1/2017 8/1/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C X OCCUR CLAIMS MADE pq ��ENEC $RETENTION DEDUCTIBLE Px $ 10,000 $ WORKER'S COMPENSATION AND 72 WE AB 2915 8/1/2017 8/1/2018 X TORY LIMIT OER B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE BLANKET WAIVER OF EL EACH ACCIDENT $ 1,000,000 OFFICER]MEMBEREXCLUDED? If yes, describe under SUBROGATION ELUiSEASE - EA =_MPLOYEE $ 1.000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS * A NOTE ABOUT HARTFORD'S CGL POLICY FORM HG0001: BURKE CLIENTS WITH WRITTEN CONTRACTS AUTOMATICALLY SECURE ADDITIONAL INSURED STATUS UNDER HARTFORD'S COMMERCIAL GENERAL LIABILITY POLICY. THE POLICY FORM HG0001 ALSO PROVIDES PRIMARY/ NON-CONTRIBUTORY INSURANCE, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION WHERE REQUIRED. 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 DATE THEREOF, THE ISSUING INSURER WILLik�i MAIL 30 DAYS WRITTEN CITY OF MEN I ATTN: CITY ADMINISTRATOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XXX �4x&xgXJGXXXX 29714 HAUN RD. �6D�4XX� txIxxxxx�CIXAxxxxxwxm QxJ1ciX1DOWA Q-xXxCX d�XXX MENIFEE, CA92586 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1-TchRIBCS-,wy, CPCU, ARM AGUKU Zb (ZUU9/US) © ACORD CORPORATION 1988 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 Organization(s): Any person or organization from whom you are required by written contract or agreement to obtain Additional Insured status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section If — 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 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1