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c OR T. CERTIFICATE OF LIABILITY INSURANCE
<br />D 07/30/2010Y)
<br />PRODUCER Serial # 100176
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />PRIMARY & EXCESS INSURANCE SERVICES, INC.
<br />BESSEY @PRIMARYINS.COM T: 805.493.5401 F: 805.492.0652
<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 />PO BOX 2002
<br />THOUSAND OAKS, CA 91358 -2002
<br />INSURERS AFFORDIN V
<br />NAIC#
<br />INSURED
<br />INSURER A: HARTFORD AS M
<br />BURKE, WILLIAMS & SORENSEN, LLP
<br />INSURER B:
<br />444 S. FLOWER ST., SUITE 2400
<br />INSURER C: UNDERW _t AT LLOYDS, LON
<br />LOS ANGELES, CA 90071
<br />INSURER D: ULL =1
<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 />INSR
<br />LTR
<br />ADD'L
<br />NSR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />DATE MM /DD/YY
<br />POLICY EXPIRATION
<br />DATE MM /DD/YY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE u OCCUR
<br />72 UUN UR 4713
<br />FORM HG 0001 0605
<br />8/1/2010
<br />8/1/2011
<br />DAMAGEToRENTED
<br />$ 300,000
<br />MED EXP (Anyone person )
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />X ADD'L INSD
<br />X
<br />SEE REMARKS (1)
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />PRO-
<br />X POLICY F1 JJE LOC
<br />XXXXXXXXXXXXXX
<br />A
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />72 UUN UR 4713
<br />P`s
<br />ppp
<br />8/1/2010
<br />O FORM
<br />8/1/2011
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />(Peril r INJURY person)
<br />$
<br />X HIRED AUTOS
<br />X NON -OWNED AUTOS
<br />�-
<br />JOSEp Q_T T
<br />ETCHER
<br />RN'
<br />BODILY INJURY
<br />(Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />GARAGE LIABILITY
<br />AUTO ONLY - EA ACCIDENT
<br />$
<br />OTHER THAN EA ACC
<br />$
<br />R ANY AUTO
<br />$
<br />AUTO ONLY: AGG
<br />A
<br />EXCESS /UMBRELLA LIABILITY
<br />X OCCUR 0 CLAIMS MADE
<br />72XHU UR 1585
<br />8/1/2010
<br />8/1/2011
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />DEDUCTIBLE
<br />RETENTION $
<br />$
<br />X
<br />WORKER'S COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PR PIETv :;PARTNER /EXECLiTIwE
<br />OFFICER /MEMBER EXCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS below
<br />' SPECIFIC EMPLOYERS'
<br />CERTIFICATE IS ISSUED
<br />BY ISU / STANTON INS *'
<br />4/1/2010
<br />4/1/2011
<br />X I TORY LIMITS I OER
<br />L EACH ACCIDENT
<br />$
<br />EL DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />EL DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />OTHER
<br />BO 595 EO 070330 2010
<br />1/15/2010
<br />1/15/2012
<br />LIMIT: $10,000,000 PER CLAIM AND
<br />LAWYERS PROFESSIONAL
<br />(2 YRS)
<br />ANNUAL AGGREGATE; SIR: $250,000
<br />LIABILITY INSURANCE
<br />DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
<br />NOTE (1) GENERAL LIABILITY POLICY EXCLUDES PROFESSIONAL SERVICES- REFER TO LAWYERS PROFESSIONAL LIABILITY POLICY. NOTWITHSTANDING THE EXCLUSION IN NOTE (1), PARTIES WITH
<br />WRITTEN CONTRACTS WITH INSURED ARE AUTOMATICALLY INCLUDED AS ADDITIONAL INSUREDS UNDER HARTFORD'S COMMERCIAL GENERAL LIABILITY POLICY FORM HG 0001 0605, INCLUDING
<br />PROVISIONS FOR PRIMARY/ NON - CONTRIBUTORY INSURANCE, SEPARATION OF INTERESTS, AND WAIVER OF SUBROGATION TO THE EXTENT THAT COVERAGE MAYBE PROVIDED UNDER THAT POLICY.
<br />POLICIES, ENDORSEMENTS, CLARIFICATIONS, AND /OR ADDITIONAL DOCUMENTATION IS AVAILABLE UPON REQUEST.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DE RI N ED EFORE THE EXPIRATION
<br />CITY OF SANTA ANA
<br />DATE THEREOF, THE ISSUING I S M L 30 DAYS WRITTEN
<br />ATTN: INDHIRA GAGNON
<br />NOTICE TO THE CERTIFICATE &vQy4xUX
<br />20 CIVIC CENTER PLAZA, 7TH FLOOR
<br />Xa➢(d0£X CX�C
<br />SANTA ANA, CA 92702
<br />REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE Nwar
<br />/S/ JOHN A BESSEY, CPCU
<br />ACORD 25 (2001108) @ ACORD CORPORATION 1988 =
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