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4CO & CERTIFICATE OF LIABILITY INSURANCE
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<br />ODI
<br />eA 1122V2019
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<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 he 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 certiflcate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />State Farm SKALA INSURANCE AGENCY INC
<br />FF
<br />PHONE N 909-883-8861 NI
<br />Na ® 4214 N SIERRA WAY
<br />ALss;
<br />_
<br />INSURERLS) AFFORDING COVERAGE NAI:#
<br />SAN BERNARDINO, CA 92407
<br />INSURER A: Slate Farm General Insurance Company 25151
<br />-INSURED
<br />INSURER a: State Farm Mutual Automobile Insurance Company 25178
<br />INSURER C:
<br />NANCY K KOHL INC
<br />INSURERo:
<br />DBA THE COUNSELING TEAM INTERNATIONAL
<br />IRU" E:
<br />AND DBA THE ORGANIZATIONAL NETWORK
<br />is u;;:,-
<br />MEDEXP n one eradnl 6 5,000
<br />COVERAGES
<br />COVERAGES CERTIFICATE 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 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 />ILT�R
<br />TYPE OF INSURANCE
<br />POLICYNUMBER
<br />MPGUCYEFF
<br />POUCYEXP
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE E 1.000,000
<br />CLAIMS -MADE ® OCCUR
<br />P IIa1VOWAOlEq p�VvrtJa 1y S 3001000
<br />MEDEXP n one eradnl 6 5,000
<br />HIRED AUTO
<br />ENOL
<br />'ERSONALIAO"IIIRY E
<br />A
<br />Y
<br />Y
<br />92LB14261 &92YD04220
<br />05/10r2018
<br />07112/2019
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE E 2,000,000
<br />POLICY a PE�a LOC
<br />PRODUCTS-COMPAIPAGG E
<br />E
<br />OTH :
<br />AUTOMOBILE
<br />UARIUDY
<br />4414187F2475
<br />12/2412016
<br />06/24/2019
<br />OMBINEDSINGLEtuar S
<br />BODILY INJURY (Per person) 5 1,000,000
<br />ANY AUTO
<br />R
<br />OWNED$DHEDDLED
<br />AUTOS ONLY CK AUTOS
<br />BODILY INJURY(Paraccidsrd) E 1,000,000
<br />PROPERTY DA MADE E 1,000,000
<br />Per Er
<br />HIRED NON4 MEO
<br />AUTOS ONLY AUTOS ONLY
<br />UMBREUA LMeOCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE S
<br />EXCESS UAB
<br />CLAIM54dADE
<br />DEC RETENTION 5
<br />5
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑
<br />OFFICERIMEMSER EXCLUDED?
<br />NIA
<br />PER H-
<br />TAT T ER
<br />EL EACH ACCIDENT E
<br />E- L. DISEASE- EA EMPLOYEIIJ $
<br />(Mandatary in son -
<br />It Yes, de9Cdba llMer
<br />DESCRIPTION OF OPERATIONEI
<br />EL. DISEASE -POLICY LIMIT $
<br />DESCRIPnONOFOPERATIONS/LOCATIONS/VEHICLES (AGGRO 101, Addaidnal Rmnarka Schetlule, may be attached it more span is mqulredl
<br />Business Office Policy Property Locations:
<br />1881 Business Center Dr, San Bernardino, CA 92408 39755 MUNI Hot Springs Rd, Ste D160, Murrieta, CA 92563
<br />1545 Anacapa Rd Ste 7C, Vlctorvllle, 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 AB, Palm Desert, CA 92260
<br />232 W Harrison Ste D, Claremont, CA 91711
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, DRDANCE WITH THE POLICY PROVISIONS.
<br />AGENTS, VOLUNTEERS & REPRESENTATIVES- ---
<br />20 CIVIC CENTER PLZ A"41
<br />SANTA ANA, CA 92701.4058 /. /
<br />©19 015 ACORD CO OI T AIN is reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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