|
r
<br />CERTIFICATE E OF LIABILITY INSURANCE
<br />DATE(MM/DDIYYYY)
<br />05/10/2018
<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(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />tateFarrf SKALA INSURANCE AGENCY INC
<br />4214 N SIERRA WAY
<br />SAN BERNARDINO, CA 92407
<br />4N—
<br />CONTACT
<br />NAME:
<br />PHONE 909-883-8861 FAX
<br />A1C o E AIC No):
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />2011_251_01
<br />INSURER A; State Farm General Insurance Company 25151
<br />INSURED
<br />NANCY K BOHL INC
<br />DBA THE COUNSELING TEAM INTERNATIONAL
<br />AND DBA THE ORGANIZATIONAL NETWORK
<br />INSURER B: State Farm Mutual Automobile Insurance Company 25178
<br />INSURER C:
<br />INSURER O:
<br />INSURER E:
<br />INSURER F:
<br />�I vmnAur_a CEki IFIGA IE NUMBER: REVISION NUMBER•
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRADDL
<br />LTR
<br />TYPE OF INSURANCE
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYWY
<br />LIMITS
<br />COMMERCIAL GENERALLIA131UTY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE ® OCCUR
<br />DAMAGE TO RENTED__
<br />PREMISES fEa occurrence 5 300,000
<br />HIRED AUTO
<br />MED EXP (Any one person) $ 5,000
<br />ENOL
<br />PERSONAL &.ADV INJURY $
<br />A
<br />Y
<br />Y
<br />92LB14261 & 92YD04220
<br />05/10/2018
<br />07/12/2019
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS - COMPfOP AGG $
<br />POLICY ❑ JECT LOC
<br />OTHER:
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />4414187F2475
<br />05/10/2018
<br />12/24/2018
<br />COM
<br />Ea aocidenDtSINGLE LIMIT $
<br />ANY AUTO
<br />BODILY INJURY (Per person) $ 1,000,000
<br />B
<br />OWNED SCHEDULED
<br />x
<br />BODILY INJURY (Per accident) $ 1,000,000
<br />AUTOS ONLY AUTOS
<br />HIREAUTO AUTOSNON-OMI ONLY
<br />AUTOS ONLY ,4UT05 ONLY
<br />PROPERTY DAMAGE $ 1,000,000
<br />Per acc,dent
<br />S
<br />I
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />DED P,ETENTION S
<br />!$
<br />WORKERS COMPENSATION
<br />PER DTH -
<br />AND EMPLOYERS' LIABILITY YIN
<br />STATUTE ER
<br />EACH ACCIDENT $
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />N I A
<br />Mandatory in N
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEE S
<br />E.L. DISEASE - POLICY LIMIT S
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Business Office Policy Property Locations:
<br />1881 Business Center Dr, San Bernardino, CA 92408 39755 Murrieta Hot Springs Rd, Ste D160, Murrieta, CA 92563
<br />1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821
<br />444 Camino Del Rio Ste 2015,San Diego, CA 92108 7220 Avenida Encinas Ste 125, Carlsbad, CA 92011
<br />74075 EI Paseo Ste A9, Palm Desert, CA 92260
<br />232 W Harrison Ste D, Claremont. CA 91711
<br />ti rzn I INCA I t HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />SANTA ANA POLICE DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
<br />60 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 927D2 A IZE REPRESENTA
<br />01 e p, I/ -L
<br />©1988-201 OR C R 1 A Ig reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />'/ _/►: 1001466 132849.12 03-16-2016
<br />
|