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AC REmm CERTIFICATE OF LIABILITY INSURANCE
<br />D03/29/2013Y)
<br />PROD�cEa Serial # 100176
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ISU I NSURiANCE SERVICES /STANTON &ASSOCIATES
<br />CA LICENSE 01350569 T: 805.495.6999 F: 805.379.4196
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
<br />3625 THOUSAND OAKS BLVD., SUITE 319
<br />WESTLAKE VILLAGE, CA 91362
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />BURKE, WILLIAMS & SORENSEN, LLP �,O\
<br />ATTN: ADMINISTRATIVE OFFICE , 9
<br />W
<br />444 S. FLOWER ST., SUITE 2400
<br />INSURER A: HARTFORD CASUALTY COMPANY
<br />INSURERS: TRAVELERS PROPERTY &CASUALTY
<br />INSURER C: UNDERWRITERS AT LLOYDS LONDON
<br />INSURER D:
<br />LOS ANGELES, CA 90071 /
<br />INSURER E:
<br />COVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />I
<br />ADDV
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />P LCEY EFF CTIVE
<br />CDW
<br />POLICY EXPIRATION
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE � OCCUR
<br />72 LEN UR4713
<br />FORM HG 0001 0605
<br />8/112012
<br />8/1/2013
<br />DAEMISESOEaoCC�°ence
<br />$ 300,000
<br />MEDEXP (Anyone person)
<br />$ 10,000
<br />PERSONAL &ADVINJURY
<br />$ 1,000,000
<br />X ADD'L INSUREDS
<br />X
<br />I WAIVER OF SUBRO
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />(SEE NOTE 1 BELOW)
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />X POLICY PRO LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />XXXXXXXXXXXXXX
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />72 UUN UR 4713
<br />ISO FORM CA 0001
<br />8/1/2012
<br />8/1/2013
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1.000.000
<br />BODILY person)
<br />(Per person)
<br />$
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIREDAUTOS
<br />NON -0WNED AUTOS
<br />APPROVE
<br />.
<br />AS TU
<br />9
<br />01°1Wi
<br />X
<br />BODILY
<br />(Per accitlenQ
<br />accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />(Per accldeni)
<br />$
<br />(NO OWNED AUTOS)
<br />,/
<br />""='h' f
<br />-Q.,(! CL�
<br />GARAGE LIABILITY
<br />A.S51SC3
<br />it C1I)' AIIDT.
<br />OV
<br />AUTO ONLY - EA ACCIDENT
<br />$
<br />OTHER THAN EA ACC
<br />AUTO ONLY: AGE
<br />$
<br />ANYAUTO
<br />$
<br />A
<br />EXCESSIUMBRELLA LIABILITY
<br />7 OCCUR ❑CLAIVSMADE
<br />72XHUUR1585
<br />8/1/2012
<br />8/1/2013
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />DEDUCTIBLE
<br />X RETENTION $ 10,000
<br />$
<br />B
<br />WORKER'S COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />OFFICERIMEMSER EXCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS below
<br />IJUB - 6627X65 -5 -13
<br />INCLUDES BLANKET WAIVER
<br />OF SUBROGATION
<br />4/1/2013
<br />4/1/2014
<br />X I WC STAT9 OFR
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />EL DISEASE -EA EMPLOYEE
<br />$ 1000,000
<br />EL DISEASE - POLICY LIMIT
<br />$ 1,000000
<br />C
<br />OTHER
<br />80595 EO 078360 2013
<br />1/15/2013
<br />1/15/2015
<br />LIMIT: $10,000,000 PER CLAIM AND
<br />LAWYERS PROFESSIONAL
<br />(2 YRS)
<br />ANNUAL AGGREGATE, SIR: $250,000
<br />LIABILITY INSURANCE
<br />PER CLAIM
<br />DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
<br />NOTE (1) GENERAL LIABILITY POLICY EXCLUDES PROFESSIONAL SERVICES - REFER TO LAWYERS PROFESSIONAL LIABILITY POLICY.
<br />NOTWITHSTANDING THE EXCLUSION NOTED, BURKE CLIENTS WITH WRITTEN CONTRACTS REQUIRING ADDITIONAL INSURED STATUS ARE
<br />AUTOMATICALLY RECOGNISED IN HARTFORD'S COMMERCIAL GENERAL LIABILITY POLICY FORM HIS 0001 0605, WHICH ALSO INCLUDES AUTOMATIC
<br />PROVISIONS FOR PRIMARY/ NON- CONTRIBUTORY INSURANCE, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION,
<br />COPIES OF POLICIES, FORMS OR ADDITIONAL DOCUMENTATION IS AVAILABLE UPON REQUEST.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />CITY OF SANTA ANA
<br />ATTN: CITY ATTORNEY'S OFFICE
<br />20 CIVIC CENTER PLAZA, 7TH FLOOR
<br />SANTA ANA, CA 92702
<br />DATE THEREOF, FHE'ISSUING INSURER WILLXXXX`iIX. AMAIL 30 DAYS WRITTEN
<br />NOTIC TO THE CER:11F1CATEHOLD NAMED TO THE LEFT , IXIX�GXIXJACiG),5.�%GCCNaiG�XXX
<br />d0X4X X IA�rQAQKNA' k?# Xd6�QA (XBF7WXQc>9iVPdQDBXX&(s'Cd(�XXX
<br />RE.RE ENTATIVES
<br />AUTfYORIZ#q+FETEISENTATIVE
<br />g A
<br />BESSEY, CPCU
<br />ACORD 25 (2001108) `" / " .." "ti r © ACORD CORPORATION 1988
<br />
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