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<br />"ri3/06/2004 <br /> <br />13:41 <br /> <br />7148369820 <br /> <br />CARE COUNSELING <br /> <br />- <br /> <br />ALLIED HEAL THCARE PROFESSIONAL AND SUPPLEMEW 1\ <br />INSURANCE POLICY DECl.. <br />RENEWAL DEC, ' , <br /> <br />. , <br /> <br />ATTACH THIS RENEWAL DECLARATIONS TO YOUR EXPIRING POLlCV <br /> <br />Policy Number: PHCP021386 <br /> <br />Philadelphia Indemnity Insurance Company <br /> <br />Administered by CPh ,. <br />7"1 S Dea¡!x <br />Ctw-'ð¡ <br /> <br />CAR.E Counseling Center <br />Penny VVinkler <br />1614 E, 17th 5t, Ste D <br />Santa Ana, CA 92701 <br /> <br />Affiliation: CAMFT <br />Professional Occupation: MARRIAGE&FAMll Y <br /> <br />Coverage Term From: (Effectiva Date) 03/26/04 To (Expiration Date) 03/26/05 <br />at 12:01 a.m. Standa~ Time at the Insured's Mailing Address shown above. <br /> <br />Retroactive Date (if applicable) <br /> <br />COVERAGE A - PROFESSIONAL liABiliTY COVERAGE LIMITS OF <br /> LlASI LlTY <br /> Individual - Each Incident: N/A <br /> Aaareaate: N/A <br />Association partnen;hio or Corooration - Each Incident: $1 000,000 <br /> AQQreQate: $3,000,000 <br />COVERAGE B - SUPPLEMENTAL LIABILITY COVERAGE <br /> Each Incident: $1,000,000 <br /> ACIOreaate: $3,000,000 .~'-'-- <br /> .-. <br />COVERAGE C - NON-OWNED AUTOMOBILE (optional) <br /> Each Occurrence: <br /> Aooreoate: <br /> - <br /> <br />-TpRE/.ÌmJh' <br /> <br />r"'t <br /> <br />f----- <br />, <br />~----- <br /> <br />---+---.- . <br /> <br />, <br />~I----'- <br />I <br />-c:: <br /> <br />.--------- <br /> <br />Policy Forms and Endorsement: The expiring policy forms, endorsements and limits of Insurance aDC' <br />renewal unless changes are shown on this Renewal Declaration. <br /> <br />Premium (including taxes): $590.00 <br /> <br />Call the Administrator to Verify Claims History at 1-800-875-1911 <br /> <br />ðð00 <br /> <br />Jamie Maguire, Authorized Representative <br /> <br />PHCP-01 (3/01 ) <br />