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Uat 18/11/2004 03:17 PM Sender's Fax ID: 312 -987 -0902 Page [ or z <br />Certificate of Insurance (Proof of Coverage) Date Issued: 8/11/2004 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMFNn_ RXTF.Nn nR AT TFR TUV VnVERA 1 <br />Insured Name and Mailing Address* <br />Program Administrator <br />Wesley A. Bosch <br />Administered By: <br />CPH and Associates <br />1000 E. Santa Ana Blvd. #200 <br />711 S. Dearborn, Suite 205 <br />Santa Ana, CA 92701 <br />Chicago, IL 60605 <br />*Additional insured locations are often requested by individual <br />business owners who have more than one office. Your coverage is <br />Underwritten By <br />portable, meaning that you are covered at any location for practice <br />listed <br />Philadelphia Indemnity InSUrance Company <br />underthe occupation(s) on yourpoli <br />Coverage <br />Policy #: PHCP025487 <br />Effective Date: 08/01/04 Expiration Date: 08/01/05 <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Limits of Liability <br />Coverage Part <br />EACH OCCURRENCE <br />AGGREGATE <br />Per individual claim <br />(Total amount erpokyeqjr <br />$1,000,000 <br />$3,000,000 <br />Professional Liability <br />Supplemental Liability <br />$1,000,000 <br />$3,000,000 <br />Includes: <br />A) Bodily Injury and Property Damage <br />B Personalln'ur <br />Unlimited <br />Unlimited <br />Defense Expense Coverage <br />$25,000 <br />$25,000 <br />State Licensing Board <br />Investigation Expense Coverage <br />$5,000 <br />$5,000 <br />Assault Coverage <br />$5,000 <br />$15,000 <br />Deposition Expense Benefit <br />$2,500/ person <br />$25,000 <br />Medical Expense Coverage <br />$2,500 <br />$2,500 <br />First Aid Coverage <br />Description/Special Provisions: <br />Certificate Holder <br />Cancellation <br />City of Santa Ana, its <br />Should any of the above described policy be cancelled before the expiration date <br />Officers, Agents, and <br />thereof, the issuing insurer will endeavor to mail 30 days written notice to the <br />Employees <br />certificate holder named to the left, but failure to do so shall impose no obligation <br />PO Box 1988 <br />or liability of any kind upon the insurer, its agents or representatives. <br />Santa Ana, CA 92702 <br />Holder has also been added to the policy as an <br />Authorized Representative <br />additional insured:** <br />X No <br />_Yes/ <br />` *If the certificate holder is an ADDITIONAL INSURED, the <br />policy(ies) must be endorsed. A statement on this certificate does not <br />confer rights to the certificate holder in lieu of such endorsement(s). <br />C. Philip Hodson <br />DISCLAIMER: The Certificate of insurance does not constitute a contract between the issuing insurer(s), authorized representative <br />or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the <br />policies listed thereon. <br />/XZ <br />