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DocuSign Envelope ID: D81 B2DAD-599E-4763-A300-356BB4F41 E65 <br /> CLARI-1 OP ID:VM <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 02125/20/ YY) <br /> 02125!2015 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> PFS Insurance Group-JT HONE FA <br /> 4848 Thompson Pkwy,Ste 200 AIC No Ext: Arc No <br /> Johnstown,CO 80534 E-MAIL <br /> John Hintzman ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC I <br /> INSURERA:Pinnacol Assurance CO 41190 <br /> INSURED Clarion Associates LLC INSURER B:State Auto Property&Casualty 11017 <br /> 621 17th St#2250 INSURER c:Houston Casualty Company <br /> Denver, CO 80293 <br /> INSURER D:Zu rich-Am erican Ins Co. 16535 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE POLICY EFF PO CY EXP <br /> LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> B X COMMERCIAL GENERAL LIABILITY BOP2630684 08/11/2014 08/11/2015 DAMAGE TO RENTED 3OO OOO <br /> PREMISES Ea occurrence $ , <br /> CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 <br /> X Contractual PERSONAL&ADV INJURY $ 2,000,000 <br /> X Additional Insure GENERAL AGGREGATE $ 4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 4,000,00 <br /> X POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accident) $ <br /> B X ANY AUTO BAP2400115 0811112014 08/11/2015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS PER ACCIDENT <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 <br /> B X EXCESS LIAR CLAIMS-MADE CXS2102792 08/11/2014 08/11/2015 AGGREGATE $ 2,000,000 <br /> DED X RETENTION$ 10000 $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY YIN Y L TS E <br /> A ANY PROPRIETORIPARTNER/EXECUIIVE 060755 (CO) 07/01/2014 07/01/2015 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFI d tort'Imn NH) CLUDED? L NIA C463309702 F L SC NC 07/01/2014 07/01/2015 <br /> D (Mandatory In NH) ( , , ) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> C Professional Liab. 09/22/2014 09/22/2015 Prof Liab 1,000,000 <br /> Retention 5,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) <br /> If required by written agreement, Ornage County is included as <br /> additional insured for ongoing operations under general liability. If <br /> required by written agreement a waiver of subrogation in favor of the <br /> certificate holder applies to the workers' compensation. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ORANGEC <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Orange County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NCi 27278 AUTHORIZED REPRESENTATIVE <br /> O 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />