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Insurance - Harper & Burns LLPJun 161601:49p � T® 1N. PA '`�� RQ y CERTIFICATE OF LIABILITY INSURANCE °ATEtnra'° V) WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 11 611 6 1 21)16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOETL 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 pohcy0m) must have ADDITIONAL INSURED Pmvieions of 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 notsonfer rights to the certificate holder In lieu of such endomemeh s . PROOUC9i Sfdfe&1`171 Charles W Boll Insurance Agency Inc AS47 Camino de las Mares Suite 226 CONTACT Dhanie BOtt PHONE F . 949 fi61 6272 AY 949.661 7869 EHML chadie.bott:b8nl�statefartn.com e San Clemente, CA 92673 INSURERe AF RONG COVERAGE "IC6 INSURERA: Stale Farm General Insurance Company 25151 INSURED Harper S Bums LLP, John R Harpers Professional Corporation and Alan RBums 453 6 Glassell St Orange, CA 928664905 enveeAn_vc INSURER B: INSURER C: INSURER O: INSURER E: INSURE[ F: - - -. - ED NAMED rvLralascrt: THIS IS TO CERTIFY THAT THE POLICIES INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE UI POLICY PERIOD INDICATED, 140T4V1TH&1'ANDING ANY REQUDREMENT, 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 TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS. R7H WPEOFINSURANCE ADDL SUER POLICY NUEID9L Mlo YEFF YESP - LIMnS COYNERLIAL GENERAL IIARILITY CLAYJS4=E ❑ OCCUR EACH OCCURRENCE S 1,000,000 D P oxm s LIE EXPC"wepenow, s PERSONP SAOVINJuW S 92 -EJ -Yl 22-3 04/01t2016 04/0112017 GENt AGGREGATELRMpIT�APPLESPETG GENERALAGWEGATE s 2,000'000 PRODUCTS-CONPIOPAGG S POLICYElJECT LOO OTNER s ADTOMOBILELIARILRY COMBIMO 61nGtE Pa accW.Y S Wr AUTO HOmLY IWURY(Pa pnsxQ s ONNm SCHEDULED HOOU.Y UUURY(f'a arcida,0 5 AUTOS ONLY AUTOS HOW NO"WNED AUTOS ONLY AUTOS ONLY 92 -EJ -Yl 22-3 0410112016 04/01/2017�ppER1Y�pANAGE 5 amourltseeabove $ UMBRELRA IlA6OCCUR F HOCCURRENCE s EXCEea We CLAIMS -WADE AGGREGATE $ OED RETENRONa B VI ORKERSCONPENSNnON FER O1R- AND WKOYERS`L al lnf YIN E. EACNACCDENT $ My PROPRMTORIPARTNEREKECUTNE OFRCEWMEMBER EXCLUDE01 NI0. (MenQaiS NX) ITyyes, assrMc eMa EL DISEASE-EAEMPIA S ELDISEASE-PODCYLIMIT S OEHCRWTION OFOPEMTIONS bebw DESCMPMNOFOPSMTONSTLOCATIONSIVEHICLES(ACORO 101,malRao'Om%HeB,/e,maybe ANacNatlYmore epee'IF,dMAJ Law Office SHOU LD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DAT THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH OLICY PRr11R91ANt An 9.hle r..,..... AOORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 IH Q,12 03-1621Ir5 SmeFahna WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ®om INFORMATION PAGE 23-3601-FA64 POLICY NO. 92-EB-JO68-3 COVERAGE IS PROVIDED BY REPLACES NO. 92 -CX -0436-0 STATE FARM FIRE AND CASUALTY COMPANY P.O. BOX 799100, DALLAS TX 75379-9100 1. NAMED INSURED & MAILING ADDRESS HARPER, JOHN & BURNS, ALAN DBA HARPER & BURNS LLP 453 S GLASSELL ST ORANGE CA 92866-1905 NCCI CARRIER CODE NO. 14842 FEIN 330758146 LOCATION: 453 S GLASSELL ST ORANGE CA 92866-1905 INSURED IS LIMITED LIABILITY PTNRSHP COPYRIGHT 1987 NATIONAL COUNCIL ON COMPENSATION INSURANCE ------------------------------------------------------------------------------ 2. THE POLICY PERIOD IS FROM 04[24/2016 TO 04/24/2017 12:01 A.M. STANDARD TIME AT THE INSURED'S MAILING ADD ESS. ------------------------ -------------------------- 3A. WORKERS COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO THE WORKERS COMPENSATION LAW OF THE STATES LISTED HERE: CA B. EMPLOYERS LIABILITY INSURANCE: PART TWO OF THE POLICY APPLIES TO WORK IN EACH STATE LISTED IN ITEM 3A. THE LIMITS OF OUR LIABILITY UNDER PART TWO ARE: BODILY INJURY BY ACCIDENT $ 100,000 EACH ACCIDENT BODILY INJURY BY DISEASE $ 10.0,000 EACH EMPLOYEE BODILY INJURY BY DISEASE $ 500,000 POLICY LIMIT C. OTHER STATES INSURANCE: PART THREE OF THE POLICY APPLIES TO ALL STATES EXCEPT ME, MT, NO, OH, RI, WA, WV, WY AND STATES LISTED IN 3A. D. THIS POLICY INCLUDES THESE ENDORSEMENTS AND SCHEDULES: WCOOOOOOC WC040360B WC000109C WC040601A WC000404 FE -4894.1 WC000422B WC040301C ------------------------------------------------------------------------------ 4. THE PREMIUM FOR THIS POLICY WILL BE DETERMINED BY OUR MANUALS OF RULES, CLASSIFICATIONS RATES AND RATING PLANS. ALL INFORMATION REQUIRED BELOW IS SUBJECT TO VERIFICATION AND CHANGE BY AUDIT. ------------------------------------------------------------------------------ PREMIUM BASIS TO- RATE/$100 ESTIMATED CODE NOS. AND TAL ESTIMATED AN- REMUNERA- ANNUAL CLASSIFICATIONS NUAL REMUNERATION TION PREMIUM --------------------------------------------------------------------------- 8820 307,996 .82 2,526 SALEESPERSONSAANDECLERICAL OFFICE EMPLOYEES- N.P.D. TERRORISM 9740 307,996 03 92 MINIMUM PREMIUM $ 375 CALIFORNIA TOTAL ESTIMATED ANNUAL PREMIUM $ 2,618 PREMIUM ADJUSTMENT PERIOD SHALL BE ANNUAL DEPOSIT PREMIUM $ 2,618 STATE FRAUD SURCHARGE $ 5.00 SEE SURCHARGE OVERFLOW PAGE PREPARED 02/10/2016 WC 00 00 01 04-84 COUNTERSIGNE ASPEN AMERICAN INSURANCE COMPANY Administrative Offices Statutory Home Office *V 590 Madison Avenue, 7th Floor 350 North St. Paul Street New York, NY 10022 Dallas, TX 75201 ASPEN THIS IS BOTH A CLAIMS MADE AND REPORTED INSURANCE POLICY. THIS IS A CLAIMS MADE AND REPORTED POLICY. THIS POLICY APPLIES TO THOSE CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED AND REPORTED IN WRITING TO THE COMPANY DURING THE POLICY PERIOD. UNLESS THIS POLICY IS OTHERWISE ENDORSED, CLAIM EXPENSES ARE WITHIN AND REDUCE THE LIMITS OF LIABILITY. PLEASE READ THIS POLICY CAREFULLY. LAWYERS PROFESSIONAL LIABILITY POLICY DECLARATIONS COMPANY: ASPEN AMERICAN INSURANCE COMPANY POLICY NUMBER: LPP002270-02 PRODUCER NAME& ADDRESS: B&B Protector Plans, Inc. d/b/a The Lawyer's Protector Plan 655 North Franklin Street Suite 1900 Tampa, FL 33602 1. NAMED INSURED: Harper & Burns LLP RENEWAL OF: LPP002270-01 2. ADDRESS: 453 South Glassell Street Orange, CA 92866 3. POLICY PERIOD: EFFECTIVE DATE: 04/20/2016 EXPIRATION DATE: 04/20/2017 12:01 A.M. Standard Time at the address of the Named Insured as stated in Item 1. above. 4. LIMITS OF LIABILITY (Inclusive of claim expenses �, or; exclusive of claim expenses ❑): A. $1,000,000 Limit of Liability - Each Claim B. $1,000,000 Limit of Liability - Policy Aggregate ASP LPP 062 DEC (12 13) Page 1 of 2 Aspen American Insurance Company V ASPEN SIGNATURE PAGE IN WITNESS WHEREOF, the Company has caused this Policy to be signed by its President and Secretary and countersigned where required by law on the Declarations page by its duly Authorized Representative. OAI— UL�" Secretary President ASPCO098 0213 © Aspen American Insurance Company, 2013 Page 1 of 1