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Insurance - Michael Balliet - 2015-10-17
q� Ro & CERTIFICATE OF LIABILITY INSURANCE 10� 7% 0 )5 A'SR nTEOFMSr1RANCE THIS CERTIFICATEIS 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 be endorsed. If SUBROGATIONIS 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 CONTACT NAME' PROFESSIONAL INS ASSOC INC/PHS PHONE (ac,No,ut): (866) 467-8730 Wc.Nep (888) 443-6112 141078 P:(866) 467-8730 F:(888) 443-6112n ILL PO BOX 33015 INSURER(S)AFFORDING COVERAGE WON SAN ANTONIO TX 78265 INSURERA: Sentinel Ins Co LTD INSURED RE IC-tWE IE 5 RE OCT C MICHAEL BALLIET CONSULTING, LLC s 26351 TARRASA IN COSTA MESA SASRIAR9DISTRICi MISSION VIEJO CA 92691 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A'SR nTEOFMSr1RANCE ADD $MR FOLTCFA'UATRER POLICPEFF POLICPEXP LAD'!S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $], 0 0 0, 000 CLAIMS -MADE OCCUR il DAMAGE TO RENTED 41000,000 PREMISES (Eaomunerm) X MED EXP (Any one Person) s10,000 A X General Liab 57 SBA BF6296 10/26/2015 10/26/2016 PERSONAL &ADV INJURY $1,000, 000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE s2,000, 000 POLICY JECT ❑X LOC PRODUCTS-COMP/OP AGG s2, 000, 000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea awdent) $1,000,000 BODILY INJURY (Per person) $ ANVAUTO A ALLOWNED SCHEDULED AUTOS AUTOS 57 SHA BF8296 10/26/2015 10/26/2016 BODILY INJURYPeramident ( )$ PROPERTY DAMAGE (Per accident) $ X HIREDAUTOS X NON -0 NED AUTOS $ UMBRELLA DAB OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS 1JAB CLAIMS -MADE OE REfENnONS $ WOBBF9.SCODIP&VSA]IOA' ANnEeIPWPEBSLIAB]/]IY PER ()TH- GTAME ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Ma,Marory in NH) F-1 WA E.L. DISEASE -EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTM OFOPERAT S/LOCATIONS/VEN/QMR)RD 101, AdtlBional Remarks Sehodulo, may be aaached if morespace Is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION 0 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Costa Mesa Sanitary District � Qg/ DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE 628 W 19TH ST MESA, CA 92627 7a -z- / 7 / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD PROFESSIONAL INS ASSOC INC/PHS PO BOX 33015 SAN ANTONIO TX 78265 AB 01 002338 65227 E 12 B -iIII. III -III hIII di�.u.wuIII IIIII r'.1,l°'.hl1u..11. d Costa Mesa Sanitary District 628 W 19TH ST COSTA MESA CA 92627-2716 ACORD 25 (2014101) Attachment A COSTA MESA SANITARY DISTRICT INSURANCE REQUIREMENTS All contracts with vendors, contractors and/or specialized professionals, shall be accompanied by proof of insurance that meets the following requirements: (1). Minimum Scope of Insurance. Coverage shall be at least as broad as the latest version of the following: (1) General Liability: Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001); (2) Automobile Liability: Insurance Services Office Business Auto Coverage form number CA 0001, code 1 (any auto); and (3) Workers' Compensation and Employer's Liability: Workers' Compensation insurance as required by the State of California and Employer's Liability Insurance. (2). Minimum Limits of Insurance. Applicants shall maintain limits no less than: (1) General Liability: $1,000,000 per occurrence for bodily injury, personal injury and property damage. (2) Automobile Liability: $1,000,000 per accident for bodily injury and property damage; and (3) Workers' Compensation and Employer's Liability: Workers' Compensation limits as required by the Labor Code of the State of California. Employer's Liability limits of $1,000,000 per accident for bodily injury or disease. (3) Insurance Endorsements. The insurance policies shall contain the following provisions, or Applicant shall provide endorsements on forms supplied or approved by the District to add the following provisions to the insurance policies: (A) General Liability. The general liability policy shall be endorsed to state that: (1) the District, its directors, officials, officers, employees, agents and volunteers shall be covered as additional insured with respect to the Work or operations performed by or on behalf of the Applicant, including materials, parts or equipment furnished in connection with such work; and (2) the insurance coverage shall be primary insurance as respects the District, its directors, officials, officers, employees, agents and volunteers, or if excess, shall stand in an unbroken chain of coverage excess of the Applicant's scheduled underlying coverage. Any insurance or self-insurance maintained by the District, its directors, officials, officers, employees, agents and volunteers shall be excess of the Applicant's insurance and shall not be called upon to contribute with it in any way. Attachment A (B) Automobile Liability. The automobile liability policy shall be endorsed to state that: (1) the District, its directors, officials, officers, employees, agents and volunteers shall be covered as additional insureds with respect to the ownership, operation, maintenance, use, loading or unloading of any auto owned, leased, hired or borrowed by the Applicant or for which the Applicant is responsible; and (2) the insurance coverage shall be primary insurance as respects the District, its directors, officials, officers, employees, agents and volunteers, or if excess, shall stand in an unbroken chain of coverage excess of the Applicant's scheduled underlying coverage. Any insurance or self-insurance maintained by the District, its directors, officials, officers, employees, agents and volunteers shall be excess of the Applicant's insurance and shall not be called upon to contribute with it in any way. (C) Workers' Compensation and Employers Liability Coverage. The insurer shall agree to waive all rights of subrogation against the District, its directors, officials, officers, employees, agents and volunteers for losses paid under the terms of the insurance policy which arise from work performed by the Applicant (D) All Coverages. Each insurance policy required shall be endorsed to state that: (A) coverage shall not be suspended, voided, reduced or canceled except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the District; and (B) any failure to comply with reporting or other provisions of the policies, including breaches of warranties, shall not affect coverage provided to the District, its directors, officials, officers, employees, agents and volunteers. (4) Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best's rating no less than A -:VII, licensed to do business in California, and satisfactory to the District. Named Insured: MICHAEL HALLIET CONSULTING, LLC Policy Number: 57 SBA SF8296 Effective Date: 10/26/15 Expiration Date: 10/26/16 Company Name: SENTINEL INSURANCE COMPANY, LIMITED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged. Form IH 99 41 04 09 Page 1 of 1 It TE ,,, HURTFORD U.S. DEPARTMENT OF THE TREASURY, OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by the United States. Please read this Notice carefully. The Office of Foreign Assets Control ("OFAC") of the U.S. Department of the Treasury administers and enforces economic and trade sanctions based on U.S. foreign policy and national security goals against targeted foreign countries and regimes, terrorists, international narcotics traffickers, those engaged in activities related to the proliferation of weapons of mass destruction, and other threats to the national security, foreign policy or economy of the United States. OFAC acts under Presidential national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze assets under U.S. jurisdiction. OFAC publishes a list of individuals and companies owned or controlled by, or acting for or on behalf of, targeted countries. It also lists individuals, groups, and entities, such as terrorists and narcotics traffickers designated under programs that are not country -specific. Collectively, such individuals and companies are called "Specially Designated Nationals and Blocked Persons" or "SDNs". Their assets are blocked and U.S. persons are generally prohibited from dealing with them. This list can be located on OFAC's web site at — http//www.treas.gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is an SDN, as identified by OFAC, the policy is a blocked contract and all dealings with it must involve OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Form IH 99 40 04 09 Page 1 of 1 POLICY NUMBER: 57 SBA BF8296 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR CITY OF HUNTINGTON BEACH, ITS ELECTED OR APPOINTED OFFICIALS, AGENTS, OFFICERS, EMPLOYEES, AND VOLUNTEERS 2000 MAIN STREET HUNTINGTON BEACH CA 92648 RE: LOC 002/001. Form IH 12 00 11 85 T SEQ. NO. 003 Process Date: 08/12/15 Printed in U.S.A. Page 001 Expiration Date: 10/26/16 POLICY NUMBER: 57 SBA BF8296 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 THE CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES OFFICERS AND AGENTS(CITY AND CITY PERSONNEL) C/O CERTSONLY-PORTLAND@EBIX.COM 1 CIVIC CENTER PLZ IRVINE CA 92606 CITY OF IRVINE AND ITS EMPLOYEES, REPRESENTATIVES, OFFICERS AND AGENTS PO BOX 257 PORTLAND MI 48875-0257 REF #113-373270 Form IH 12 00 11 85 T SEQ. NO. 002 Process Date: 08/12/15 Printed in U.S.A. Page 001 Expiration Date: 10/26/16 POLICY NUMBER: 57 SBA 13FB296 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION THE CITY OF HUNTINGTON BEACH, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 2000 MAIN ST HUNTINGTON BEACH, CA 92648 ATTN: RISK MANAGEMENT THE CITY OF NEWPORT BEACH, THE CITY, ITS ELECTED OR APPOINTED THE CITY OF NEWPORT BEACH, THE CITY, ITS ELECTED OR APPOINTED OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE TO BE COVERED AS ADDITIONAL INSUREDS WITH RESPECT TO LIABILITY OUT OF WORKPERFORMED BY OR ON BEHALF OF THE CONSULTANT THE CITY OF COSTA MESA AND ITS ELECTED AND APPOINTED BOARDS, OFFICERS, AGENTS, AND EMPLOYEES 77 FAIR DRIVE COSTA MESA. CA 9262e Cg 1A MESA SANITARY DISTRICT 628 W 19TH ST. COSTA MESA, CA 92627 Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001 Process Date: 08/12/15 Expiration Date: 10/26/16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM UMBRELLA LIABILTY PROVISIONS A. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of such insured losses, as indicated in the table below that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses, attributable to "certified acts of terrorism" under the federal Terrorism Risk Insurance Act, as amended (TRIA), exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. B. Cap On Insurer Liability for Terrorism Losses A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of federal Terrorism Risk Insurance Act, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: 1. The act results in insured losses in excess of $5 million in the aggregate, attributable to'all types of insurance subject to TRIA; and 2. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and 3. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals acting as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro -rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. C. Application Of Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form or Policy, such as losses excluded by the Pollution Exclusion, Nuclear Hazard Exclusion and the War And Military Action Exclusion. Form SS 50 19 01 15 Page 1 of 1 © 2015, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission) i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUILDING LIMIT- AUTOMATIC INCREASE REVISION This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. A. Paragraph C.5 Building Limit -Automatic Increase of the SPECIAL PROPERTY COVERAGE FORM or STANDARD PROPERTY COVERAGE FORM is deleted. B. The following is added to Additional Coverages, paragraph A.5 of the SPECIAL PROPERTY COVERAGE FORM or paragraph A.4. of the STANDARD PROPERTY COVERAGE FORM: Building Limit -Automatic Increase a. If the covered loss or damage to Building property at a "scheduled premises' exceeds the Limit of Insurance stated in the Declarations, the Limit of Insurance available for the covered loss or damage in that occurrence will automatically increase by up to 8%. b. The amount of increase will be: (1) The Limit of Insurance for Buildings that applied on the most recent of the policy inception date, policy anniversary date, or the date of any other policy change amending the Building limit, multiplied by (2) The 8% annualized percentage of Automatic Increase, expressed as a decimal (08), multiplied by Form SS 41 51 10 09 (3) The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance for Buildings, divided by 365. Example: The applicable Limit of Insurance for Buildings is $100,000. The automatic increase percentage is 8%. The number of days since the beginning of the policy period (or last policy change) is 146. The amount of increase is: $100,000 X.08 X 146 divided by 365 = $3,200 © 2009, The Hartford Page 1 of 1 Declarations for Temperature Change. We will then pay the amount of loss in excess of the deductible, up to the Limit of Insurance. F. LIMIT OF INSURANCE The most we will pay for direct physical loss or physical damage in any one occurrence is the Limit of Insurance for Temperature Change shown in the Declarations. G. ADDITIONAL CONDITIONS 1. We will pay for direct physical loss or physical damage under this Optional Coverage only when: (a) Such physical loss or physical damage is not covered elsewhere in this policy or any other policy that insures the "perishable stock" at the "scheduled premises"; and (b) This Temperature Change coverage is shown as a specific item of insurance in the Declarations. 2. In the event of physical loss or physical damage, none of the other coverages under this policy or any other policy will share in its payment unless the provisions of the policy are similar to the provisions of this Optional Coverage. 3. We will not pay more than the Limit of Insurance shown in the Declarations for the Temperature Change. H. ADDITIONAL DEFINITIONS For the purpose of this insurance: 1. "Mechanical breakdown" means: (a) Breaking or separation of any mechanical part(s) other than gas pipes or lines; or (b) Burning out of any electrical motor servicing such unit; and requiring replacement of the damaged parts to become functional. But "mechanical breakdown" does not mean faulty operation or failure of equipment which results in temperature change but does not require replacement of broken parts. We will not pay for direct physical loss or physical damage to "perishable stock" caused by such faulty operation or failure of equipment. 2. 'Perishable stock" means personal property: (a) Maintained under controlled conditions for its preservation; and (b) Susceptible to direct physical loss or physical damage if the controlled conditions change. Page 2 of 2 Form SS 04 46 09 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEMPERATURE CHANGE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. A. We will pay for direct physical loss of or physical damage to "perishable stock" at the "scheduled premises" caused by or resulting from: 1. A change in temperature or humidity resulting from: (a) Mechanical breakdown or failure of: (1) Stationary heating plants; or (2) Refrigerating, cooling or humidity control apparatus or equipment; But only while such plants, equipment or apparatus are at the "scheduled premises". (b) Complete or partial failure of electric power, either on or away from your "scheduled premises". Such failure of power must be due to conditions beyond your control; or 2. Contamination by a refrigerant. B. SELLING PRICE We will determine the value of finished "perishable stock" in the event of direct physical loss or physical damage at the selling price, as if no physical loss or physical damage had occurred less discounts and expenses you otherwise would have had. C. We will not pay for direct physical loss of or physical damage to "perishable stock" located: 1. On buildings; 2. In the open; or 3. In vehicles, other than trailers used for storage located within 1000 feet of the "scheduled premises'. D. EXCLUSIONS 1. The following exclusions under SECTION IS - EXCLUSIONS are deleted: (a) Ordinance or Law; (b) Power Failure; and (c) Mechanical Breakdown in the Standard Property Coverage Form. 2. The following exclusions are added: We will not pay for direct physical loss or physical damage caused by or resulting from: (a) The disconnecting of any of the following systems from the source of power: (1) Refrigerating; (2) Cooling; or (3) Humidity control. (b) The loss of electrical power caused by the shutting off of any switch or other device used to control the flow of electric power or current. (c) The inability of an electrical utility company, your stationary heating plant or any other power source to provide sufficient heat or power due to: (1) Lack of fuel; (2) Lack of capacity to make enough heat or power; or (3) Order of the government. (d) Breaking of any glass that is a permanent part of a refrigerating, cooling or humidity control unit. E. DEDUCTIBLE We will not pay for loss in any one occurrence unless the amount of loss exceeds the deductible stated in paragraph D.5. of the Standard Property Coverage Form or D.S. of the Special Property Coverage Form., unless a different deductible is stated in the Form SS 04 46 09 14 Page 1 of 2 © 2014, The Hartford a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is COMMON POLICY CONDITIONS appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named Insured. If the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. Lisa Levin, Secretary lq/�t Douglas Elliot, President Form SS 00 05 10 08 Page 3 of 3 COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud due from that other insurance, whether you can This policy is void in any case of fraud by you as it collect on it or not. But we will not pay more than relates to this policy at any time. It is also void if you the applicable Limit of Insurance. or any other insured, at anytime, intentionally conceal I. Premiums or misrepresent a material fact concerning: 1. The first Named Insured shown in the 1. This policy; Declarations: 2. The Covered Property; a. Is responsible for the payment of all 3. Your interest in the Covered Property; or premiums; and 4. A claim under this policy. b. Will be the payee for any return premiums D. Examination Of Your Books And Records we pay. 2. The premium shown in the Declarations was We may examine and audit your books and computed based on rates in effect at the time records as they relate to the policy at any time the policy was issued. Ifr applicable, on each during the policy period and up to three years renewal, continuation or anniversary of the afterward. effective date of this policy, we will compute E. Inspections And Surveys the premium in accordance with our rates and 1. We have the right but are not obligated to: rules then in effect. a. Make inspections and surveys at any time; 3. With our consent, you may continue this policy in force by paying a continuation premium for b. Give you reports on the conditions we find; each successive one-year period. The and premium must be: c. Recommend changes. a. Paid to us priorto the anniversary date; and 2. Any inspections, surveys, reports or b. Determined in accordance with Paragraph recommendations will relate only to insurability 2, above. and the premiums to be charged. We do not make safety inspections. We do not Our forms then in effect will apply. If you do undertake to perform the duty of any person or not pay the continuation premium, this policy organization to provide for the health or safety will expire on the first anniversary date that we of any person. We do not represent or warrant have not received the premium. that conditions: 4. Changes in exposures or changes in your a. Are safe or healthful; or business operation, acquisition or use of locations that are not shown in the Declarations b. Comply with laws, regulations, codes or may occur during the policy period. If so, we may standards. require an additional premium. That premium will 3. This condition applies not only to us, but also be determined in accordance with our rates and to any rating, advisory, rate service or similar rules then in effect. organization which makes insurance J. Transfer Of Rights Of Recovery Against Others inspections, surveys, reports or To Us recommendations on our behalf. Applicable to Property Coverage: F. Insurance Under Two Or More Coverages If any person or organization to or for whom we If two or more of this policy's coverages apply to make payment under this policy has rights to the same loss or damage, we will not pay more recover damages from another, those rights are than the actual amount of the loss or damage. transferred to us to the extent of our payment. G. Liberalization That person or organization must do everything If we adopt any revision that would broaden the necessary to secure our rights and must do coverage under this policy without additional nothing after loss to impair them. But you may premium within 45 days prior to, or at any time waive your rights against another party in writing: during, the policy period, the broadened coverage 1. Prior to a loss to your Covered Property; or will immediately apply to this policy. 2. After a loss to your Covered Property only if, at H. Other Insurance - Property Coverage time of loss, that party is one of the following: If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount Page 2 of 3 Form SS 00 05 10 08 COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: (a) Seasonal unoccupancy; or (b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. (2) After damage by a Covered Cause of Loss, permanent repairs to the building: (a) Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or (c) Been declared unsafe by governmental authority. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is canceled, we will send the first Named Insured any premium refund due. Such refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy Wth our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. Form SS 00 05 10 08 Page 1 of 3 © 2008, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission) QUICK REFERENCE - SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Period Description and Business Location Coverages and Limits of Insurance II. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance - Property Coverage 2 L Premiums 2 J. Transfer Of Rights Of Recovery Against Others To Us 2 K. Transfer Of Your Rights And Duties Under This Policy 3 L. Premium Audit 3 Form SS 00 05 10 08 COMMON POLICY CONDITIONS Form SS 00 05 10 08 © 2008, The Hartford The following changes apply only if Business Income and Extra Expense are covered under this policy. The Limits of Insurance for the following Business Income and Extra Expense Coverages are in addition to any other Limit of Insurance provided under this policy: Coverage Limit Business Income Extension for Off -Premises Utility Services $ 25,000 Business Income Extension for Web Sites $ 10,000/7 days Business Income from Dependent Properties $ 25,000 The following Limit of Insurance for the following Business Income Coverage is a replacement of the Limit of Insurance provided under the Standard Property Coverage Form or the Special Property Coverage Form, whichever applies to the policy: Coverage Extended Business Income The following changes apply to Loss Payment Conditions: Coverage Valuation Changes Commodity Stock "Finished Stock" Mercantile Stock - Sold Limit 60 Days Limit Included Included Included Page 2 of 2 Form SS 84 01 09 07 STRETCH SUMMARY SUMMARY OF COVERAGE LIMITS This is a summary of the Coverages and the Limits of Insurance provided by the Stretch Coverage form SS 04 08 which is included in this policy. No coverage is provided by this summary. Refer to coverage form SS 0408 to determine the scope of your insurance protection. The Limit of Insurance for the following Additional Coverages are in addition to any other limit of insurance provided under this policy: Coverage Accounts Receivable — On/Off-Premises Brands and Labels Claim Expenses Computer Fraud Computers and Media Debris Removal Employee Dishonesty (including ERISA) Fine Arts Forgery Laptop Computers — World -Wide Coverage Off Premises Utility Services — Direct Damage Outdoor Signs Pairs or Sets Personal Property of Others Property at Other Premises Salespersons' Samples Sewer and Drain Back Up Sump Overflow or Sump Pump Failure Temperature Change Tenant Building and Business Personal Property Coverage - Required by Lease Transit Property in the Care of Carriers for Hire Unauthorized Business Card Use Valuable Papers and Records — On/Off-Premises Limit $ 25,000 Up to Business Personal Property Limit $ 10,000 $ 5,000 $ 10,000 $ 25,000 $ 10,000 $ 10,000 $ 10,000 $ 5,000 $ 10,000 Full Value Up to Business Personal Property Limit $ 10,000 $ 10,000 $ 1,000 Included up to Covered Property Limits $ 15,000 $ 10,000 $ 20,000 $ 10,000 $ 2,500 $ 25,000 The Limits of Insurance for the following Coverage Extensions are a replacement of the Limit of Insurance provided under the Standard Property Coverage Form or the Special Property Coverage Form, whichever applies to the policy: Coverage Newly Acquired or Constructed Property —180 Days Building Business Personal Property Business Income and Extra Expense Outdoor Property Personal Effects Property Off -Premises Limit $1,000,000 $ 500,000 $ 500,000 $ 20,000 aggregate/ $1,000 per item $ 25,000 $ 15,000 Form SS 84 01 09 07 Page 1 of 2 © 2007, The Hartford SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA BF8296 SUPPLEMENTAL DECLARATIONS: A service fee of $ 7.00 is charged for each installment when your premium is paid in installments. The service fee is $ 5.00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. Form SS 00 45 12 06 Process Date: 08/12/15 Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SEA BF8296 Form Numbers of Forms and Endorsements that apply: SS 00 01 03 14 SS 00 05 10 08 SS 00 07 07 05 SS 00 08 04 SS 00 45 12 06 SS 84 01 09 07 SS 01 21 06 14 SS 04 08 09 SS 04 19 04 09 SS 04 22 07 05 SS 04 30 07 05 SS 04 38 09 SS 04 39 07 05 SS 04 41 04 09 SS 04 42 09 07 SS 04 44 07 SS 04 45 07 05 SS 04 46 09 14 SS 04 47 04 09 SS 04 80 03 SS 04 86 03 00 SS 40 18 07 05 SS 40 93 07 05 SS 41 12 12 SS 41 51 10 09 SS 41 62 06 11 SS 41 63 06 11 IH 10 01 09 SS 05 09 07 00 SS 05 47 09 01 SS 50 19 01 15 IH 99 40 04 IH 99 41 04 09 SS 38 25 12 07 SS 83 76 01 15 IH 12 00 11 85 ADDITIONAL INSURED - PERSON -ORGANIZATION IH 12 00 11 85 ADDITIONAL INSURED - STATE/POLITICAL SUBDIVISION IH 12 00 11 85 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR 05 07 09 05 00 07 86 09 Form SS 00 02 12 06 Page 009 Process Date: 08/12/15 Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SSA BF8296 ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 TYPE PERSON ORGANIZATION NAME SEE FORM IH 12 00 TYPE STATE POLITICAL SUBDIVISION NAME SEE FORM IH 12 00 LOCATION 002 BUILDING 001 TYPE OWNER, LESSEES OR CONTRACTORS NAME SEE FORM IH 12 00 Form SS 00 02 12 06 Page 008 (CONTINUED ON NEXT PAGE) Process Date: 08/12/15 Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA BF8296 BUSINESS LIABILITY LIABILITY AND MEDICAL EXPENSES MEDICAL EXPENSES -ANY ONE PERSON PERSONAL AND ADVERTISING INJURY DAMAGES TO PREMISES RENTED TO YOU ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS -COMPLETED OPERATIONS FORM SS 05 09 GENERAL AGGREGATE BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY Form SS 00 02 12 06 Process Date: 08/12/15 LIMITS OF INSURANCE $1,000,000 $ 10,000 $1,000,000 $1,000,000 $2,000,000 $2,000,000 $1,000,000 Page 007 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA BF8296 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO ALL LOCATIONS BUSINESS INCOME AND EXTRA EXPENSE COVERAGE 12 MONTHS ACTUAL LOSS SUSTAINED COVERAGE INCLUDES THE FOLLOWING COVERAGE EXTENSIONS: ACTION OF CIVIL AUTHORITY: 30 DAYS EXTENDED BUSINESS INCOME: 30 CONSECUTIVE DAYS EQUIPMENT BREAKDOWN COVERAGE COVERAGE FOR DIRECT PHYSICAL LOSS DUE TO: MECHANICAL BREAKDOWN, ARTIFICIALLY GENERATED CURRENT AND STEAM EXPLOSION THIS ADDITIONAL COVERAGE INCLUDES THE FOLLOWING EXTENSIONS HAZARDOUS SUBSTANCES $ 50,000 EXPEDITING EXPENSES $ 50,000 MECHANICAL BREAKDOWN COVERAGE ONLY APPLIES WHEN BUILDING OR BUSINESS PERSONAL PROPERTY IS SELECTED ON THE POLICY IDENTITY RECOVERY COVERAGE $ 15,000 FORM SS 41 12 Form SS 00 02 12 06 Page 006 (CONTINUED ON NEXT PAGE) Process Date:08/12/15 Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SEA BF8296 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 002 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION STRETCH COVERAGES FORM: SS 04 08 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. LIMITED FUNGI, BACTERIA OR VIRUS COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: Form SS 00 02 12 06 Process Date: 08/12/15 $ 50,000 30 DAYS Page 005 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA BF8296 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 002 Building: 001 18391 GOLDENWEST ST HUNTINGTON BEACH CA 92648 Description of Business: Consultant - NOC Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING BUSINESS PERSONAL PROPERTY REPLACEMENT COST PERSONAL PROPERTY OF OTHERS REPLACEMENT COST MONEY AND SECURITIES INSIDE THE PREMISES OUTSIDE THE PREMISES Form SS 00 02 12 06 Process Date: 08/12/15 NO COVERAGE $ 7,400 NO COVERAGE $ 10,000 $ 5,000 Page 004 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA EF8296 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION STRETCH COVERAGES FORM: SS 04 08 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. LIMITED FUNGI, BACTERIA OR VIRUS COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: Form SS 00 02 12 06 Process Date: 08/12/15 $ 50,000 30 DAYS Page 003 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 10/26/16 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 57 SBA BF8296 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: oo1 26351 TARRASA LN MISSION VIEJO CA 92691 Description of Business: Consultant - NOC Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING BUSINESS PERSONAL PROPERTY REPLACEMENT COST PERSONAL PROPERTY OF OTHERS REPLACEMENT COST MONEY AND SECURITIES INSIDE THE PREMISES OUTSIDE THE PREMISES Form SS 00 02 12 06 Process Date: 08/12/15 NO COVERAGE $ 7,400 NO COVERAGE $ 10,000 $ 5,000 Page 002 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 10/26/16 96 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 82 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock BF insurance company of The Hartford Insurance Group shown below. SBA INSURER: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: A �y Policy Number: 57 SBA BF8296 DX itiL HARTFORD SPECTRUM POLICY DECLARATIONS Named Insured and Mailing Address: MICHAEL BALLIET CONSULTING, LLC (No., Street, Town, State, Zip Code) 26351 TARRASA LN MISSION VIEJO CA 92691 Policy Period: From 10/26/15 To 10/26/16 1 YEAR 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: PROFESSIONAL INS ASSOC INC/PHS Code: 141078 Previous Policy Number: 57 SBA BF8296 Named Insured Is: LIMITED LIAB CORP Audit Period: NON -AUDITABLE Type of Property Coverage: SPECIAL Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $500 MP e.1`GlO�tiuc�c7.> Countersigned by 08/12/15 Authorized Representative Date Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 08/12/15 Policy Expiration Date: 10/26/16 IMPORTANT NOTICE TO POLICYHOLDERS To help your insurance keep pace with increasing costs, we have increased your amount of insurance ... giving you better protection in case of either a partial, or total loss to your property. If you feel the new amount is not the proper one, please contact your agent or broker. Form PC -374-0 Printed in U.S.A. D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro -rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 Page 2 of 2 POLICY NUMBER: 57 SBA BF8296 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $8.00 A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement. B. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous , to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of insured losses, as indicated in the table below, attributable to "certified acts of terrorism" under TRIA that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses under TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. Form SS 83 76 01 15 Page 1 of 2 © 2015 , The Hartford (Includes copyrighted material of the Insurance Services Office, Inc., with its permission.) THE HARTFORD PRODUCER COMPENSATION NOTICE You can review and obtain information on The Hartford's producer compensation practices at www.TheHartford.com or at 1-800-592-5717. Form G-3418-0 Spectrum Business Owner's Policy THE HARTFORD Form SS 00 01 03 14 Page 1 of 1 Insurance Policy Billing Information Thank you for selecting The Hartford for your business insurance needs. Shortly, you will receive your first bill from us. You are receiving this Notice so you know what to expect as a valued customer of The Hartford. Should you have any questions after reviewing this information, please contact us at 866-467-8730, and we will be happy to assist you. o Your total policy premium will appear on your policy's Declarations Page. You will be billed based on the payment plan you selected. o You may pay the "minimum due" as it appears on your insurance bill or pay the policy balance in full. o An installment service fee is added to each installment. A late fee will also be applied if the "minimum due" is not received by the due date shown on your bill. Service and late payment fees do not apply in all states. o If you selected installment billing, any credit or additional premium due as the result of a change made to your policy, will be spread over the remaining billing installments. Additional premium due as a result of an audit will be billed in full on your next bill date following the completion of the audit. o If you elected Electronic Funds Transfer (EFT), policy changes may result in changes to the amount automatically withdrawn from your bank account. The invoice you receive following a policy change will include future withdrawal amounts. If you need to adjust or stop your next scheduled EFT withdrawal, please contact us at least 3 days prior to the scheduled withdrawal date at the telephone number shown below. o If you selected installment billing and pay the premiums for your first policy term on time, at renewal, your account may qualify for our "Equal Installment" feature. This means that the percentage due for each installment, including the initial renewal installment, will be the same throughout the policy term — helping you better manage cash flow. Equal installments will continue as long as you pay your premiums on time and no cancellation notices are issued for any policy on your account. If you no longer qualify for Equal Installments, future renewals will be billed based on the payment plan you selected, which includes a higher initial installment amount. o If your policy is eligible for renewal, your bill for the upcoming policy term will be sent to you approximately 30 days prior to your policy's renewal date. If your insurance needs change, please contact us at least 60 days prior to your renewal date so we can properly address any adjustments needed. o One bill convenience -- you have the option of combining all eligible Hartford policies on one single bill allowing you to make one payment for all policies on your account as payments are due. You're In Control In addition to selecting a bill plan option that best meets your budget, you have the flexibility to decide how your payments are made ... o Repetitive EFT: Sign up for Repetitive EFT payments and have payments automatically withdrawn from your bank account. This option saves you money by reducing the amount of the installment service fee. o Pay Online: Register at www.thehartford.com/servicecenter. Online Bill Pay is Quick, Easy and Secure! o Pay by Check: Send a check with your remittance stub in the envelope provided with your bill. o Pay by Phone: Call toll-free 1.866-467.8730. Should you have any questions about your bill, please call Customer Service toll-free number: 1-866-467-8730 - 7AM — 7PM CST. We look forward to being of service to you. Form 100722 11th Rev. Printed in U.S.A. tuy MICHAEL BALLIET CONSULTING, LLC THE 26351 TARRASA LN HARTFORD MISSION VIEJO CA 92691 Policy Number: 57 SBA BF8296 Renewal Date: 10/26/15 Thank you for being a loyal customer of The Hartford. # 1: Your Hartford Policy Enclosed are renewal documents for your policy, which is scheduled to renew on 10/26/15 . Along with a new Declarations Page, which details the coverages provided by your policy, we are enclosing important policy documents. Please be aware that you will receive an invoice separately for this new policy term approximately 30 days prior to the renewal date; no action is required now. To ensure the premium you paid for this past policy term was accurate, we may contact you by letter, phone or email to conduct a premium audit. If contacted, we will advise what information is needed to complete the audit. # 2: Your Business Insurance Coverage Checkup Now is a great time to complete a business insurance coverage checkup with a Hartford Insurance Professional. Because you wear so many hats each day, you may not be thinking about how changes to your business can impact the type and amount of insurance coverage needed to protect it. Together we will evaluate how your needs may have changed over the past year. Examples include: - Has your mailing address and/or the physical location of your business changed? - Has there been any increase/decrease in the amount of business property/equipment you own? - Has there been any increase/decrease in your company's payroll or sales? - Have you added or eliminated any vehicles used in your business operations? - Are the bill plan and deductible on your policy right for your business? During the review we may make coverage recommendations, provide peace of mind solutions, and possibly reduce your costs. Here is all you need to do: - Call toll free (866) 467-8730 , and select our renewal review service option any weekday from 7 A.M. to 7 P.M. CST and request your business insurance check-up. - To best serve you, please have your Policy Number or Account Number and a Copy of your current Renewal Policy in hand when you call. # 3: Servicing Your Needs To login or register for our Online Business Service Center, go to www.thehartford.com/servicecenter where anytime, day or night you can: - Pay your bill, view payment history and enroll in Auto Pay - Request Auto ID Cards and Certificates of Insurance - View electronic copies of billing and policy documents and sign up for paperless delivery # 4: If You've Had A Loss or Accident... Report It Immediately We want to help! Contact us as quickly as possible at 1-800-327-3636. - Representatives are available 24-7 to assist in helping you recover from your loss. On behalf of PROFESSIONAL INS ASSOC INC/PHS and The Hartford, we appreciate the opportunity to have been of service to you this past year and look forward to serving your business insurance needs for the upcoming year. Sincerely, Your Hartford Team IMPORTANT NOTICE TO OUR POLICYHOLDERS THANK YOU FOR RENEWING YOUR POLICY WITH THE HARTFORD. WITH THIS NOTICE WE ARE PROVIDING YOU ONLY WITH THE DECLARATIONS PAGE, WHICH OUTLINES YOUR COVERAGES, AND WITH THOSE POLICY FORMS, NOTICES, AND BROCHURES WHICH ARE DIFFERENT FROM THOSE WHICH WE PROVIDED WITH YOUR PREVIOUS POLICY. YOU SHOULD RETAIN ALL OF THESE DOCUMENTS AND THOSE PROVIDED WITH YOUR PREVIOUS POLICY INDEFINITELY SO THAT YOU WILL HAVE A COMPLETE SET OF POLICY FORMS AT ALL TIMES FOR YOUR REFERENCE. IF YOU HAVE QUESTIONS, OR IF AT ANY TIME YOU NEED COPIES OF ANY OF THE FORMS LISTED ON YOUR POLICY, PLEASE CALL YOUR HARTFORD AGENT OR BROKER, OR THE OFFICE OF THE HARTFORD IDENTIFIED ON YOUR POLICY, AS APPROPRIATE. Form G-3187-0