2021/08/01 Burke, Williams & Sorensen, LLPACURV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
07/21 /2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CO TACT Kasey Litz
NAME:
Stanton and Associates Inc PHONE (805) 413-1498 805) 435-3737
A/C No.
o Ext :1
tAICNII:
ISU Stanton &Associates L.MAtLSS: kasey@isustanton.com
3625 Thousand Oaks Blvd #319 INSURER(S) AFFORDING COVERAGE NAIC #
Westlake Village CA 91362 INSURER A : Hartford Fire Insurance Company 19682
INSURED INSURER B : Hartford Casualty Ins CO 29424
Burke, Williams & Sorensen, LLP INSURER C : Property & Casualty Insurance Co. of Hartford 34690
444 S Flower St , Suite 2400 INSURER D:
INSURER E :
Los Angeles CA 90071 1INSURER F :
CnVFRAGFS OFRTIFICATF NIIMRFR- 21-22 City RCVICInIJ NI IMRCA•
THIS IS TO CERTIFY THAT 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 POLICIES DESCRIBED HEREIN IS SUBJECT TC ^tL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LT
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
IMMIDD/YYYY
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_] OCCUR
EACH OCCURRENCE
$ 1.000,000
PREMISES JEa ocwru ance
$ 300,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000.000
A
Y
72UUNUR4713
08/01/2021
08/01/2022
GENI'L AGGREGATE LIMITAPPLI ES PER:
POLICY j� LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
CEa ril) LE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
72UUNUR4713
08/01/2021
08/01/2022
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
H
PROPERTY DAMAGE
Per accident
$
$
X
UMBRELLA LIAR
X OCCUR
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$
B
EXCESS LIAB
CLAIMS -MADE
72XHUUR4585
08/01/2021
08/01/2022
DED I X RETENTION 3 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatary in Nfl)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
72UUNUR4713
08/01/2021
08/01/2022
PER OTH-
STATUTE ER
E.L EACH ACCIDENT
$ 1,000,000
F.L DISEASE - EA EMPLOYEE
$ 1,000.000
E.L DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Hartford CGL policy form HG0001 includes Additional Insured status, Primary and Non -Contributory wording, and Waiver of Subrogation where required by
written contracts.
IH 0303 - 30 Day NOC applies
CG2026 —Additional Insured — Designated Person or Organization
WC 990394 — 30-Day Notice of Cancellation to Certificate Holders
WC040306 — WC Waiver of Subrogation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Menifee Attn: City Administrator ACCORDANCE WITH THE POLICY PROVISIONS.
29714 Haun Rd
AUTHORIZED REPRESENTATIVE
Menifee CA 92586 7
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