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PIU LAI) E LP IUA
<br />- 1NYritANVE COMVAniv.s
<br />E Ai.GfI CiATi. ii
<br />Certificate of Liability Insurance
<br />Date Issued: 06/26/2018
<br />underwritten by; Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 .Bala Gynwyd, PA 19004, NAIC #: 18058
<br />Administered by: CPH & Associates - 711 S. Dearborn St. Ste 205 Chicsgo, IL 60605 P800.87,5,1911 F312,967,0902 inhe@cphins.com
<br />DISCLAIMER: This certificate is issued as a smatterer information only and confers no rights upon the certificate holder, The Certificate of Insurance does not
<br />constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, hardness it affirmatively or negatively amend,
<br />extend, or alter the coverage afforded by the policies listed thereon.
<br />Insured: Wesley A Bosch Policy Number: 081041
<br />24001 Muirlands Blvd Spc 331 Policy Term: 08/21/2018 to 08!21/2019
<br />Lake Forest, CA 92630 Occupation: Licensed Marriage and Family
<br />Therapist
<br />Covered Locations
<br />Professional Liability: Portable coverage, not location specific
<br />General Liability insured Location(s);
<br />25283 Cabot Rd., Suite 204, Laguna Hills, CA 92663
<br />Coverage Type
<br />Per incident
<br />Aggregate
<br />(Occurrence Form)
<br />(Per individual claim)
<br />(Total amount per year)
<br />Professional Liability
<br />$1,000,000
<br />$ 3,000,000
<br />Supplemental Liability
<br />$ 1,000,000
<br />$ 3,000,000
<br />Licensing ;Board Defense
<br />$ 35,000
<br />$ 35,000
<br />Commercial General
<br />Liability
<br />$ (000,000
<br />$ 3,000,000
<br />FrreMlaPer Legal Liability
<br />$ 250,000
<br />$ 250,000
<br />Business Personal Property
<br />NIA
<br />NIA
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<br />Comments/Special Descriptions:.
<br />Certificate Holder
<br />City of Santa Ana, its Officers, Agents, and Employees
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />L� Certificate Holder has been added as an additional insured
<br />If the Certificate holder in an ADDITIONAL INSURED, the policy(ies} must be endorsed. A statement on this cert'dicate doe, not conic; right, to the cerhicats holder in
<br />ties of such eodorsemenhi,). Notice of Cancellation will only be provided to the first named insured in accordance rdth policy provisions, who shall art on behalf of all
<br />additional insured, with respect to giving notice of cancellation.
<br />Authorized Representative
<br />C. Philip Hodson
<br />
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