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BOSCH, WESLEY A., M.A. MFT
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BOSCH, WESLEY A., M.A. MFT
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Last modified
3/13/2019 9:57:39 AM
Creation date
3/13/2019 8:23:00 AM
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Template:
Contracts
Company Name
BOSCH, WESLEY A., M.A. MFT
Contract #
N-2019-042
Agency
COMMUNITY DEVELOPMENT
Expiration Date
6/30/2020
Insurance Exp Date
8/21/2019
Destruction Year
2025
Notes
AUTO AND WC COVERAGE WAIVED BY RYAN HODGE (CAO)
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THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREIFt7, L9 Y <br />Additional Insured Endorsement <br />This endorsement modifies insurance provided under the following: <br />ALLIED HEALTHCARE PROVIDERS PROFESSIONAL <br />AND SUPPLEMENTAL LIABILITY POLICY <br />In consideration of the premium paid, this policy is amended as follows <br />City of Santa Ana, its Officers, Agents, and Employees is hereby added as an Additional Insured, solely <br />for Damages arising out of a Professional Incident covered under this policy. The Professional <br />Incident must arise out of services provided by the Insured, under contract with City of Santa Ana, its <br />Officers, Agents, and Employees. <br />Additional Insured Name and Mailing Address: <br />City of Santa Ana, its Officers, Agents, and Employees <br />20 Civic Center Plaza <br />Santa Ana, CA, 92702 <br />All other terms and conditions of this policy remain unchanged. This endorsement is part of your policy and <br />takes effect on the effective date of your Policy, unless another effective date is shown below, <br />Policy, 081041 <br />Effective on and after: 08/21/2018 <br />Issued to: Wesley A Bosch <br />Expiration date: 08121/2019 <br />PI-PiCP-06 (03/01) <br />By: Robert O'Leary, Authorized Representative <br />
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