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Certificate of Insurance (Proof of Coverage)Date Issued: 8/22/2014
<br />THUS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIFFS UPON TI E CERTIFICATE
<br />HOLDER. THIS CER'T'IFICATE DOES NOT AMEND EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Xlisured,l\7ame IVIailEn Address *;;
<br />Prti randmiistlator; ;?
<br />and •; ;
<br />Wesley A Bosch
<br />Administered By:
<br />CPH and Associates
<br />7t1 S. Dearborn, 205
<br />1000 E Santa Ana Blvd Suite 200
<br />C is o, IL 0605
<br />Chicago, IL 312-9
<br />Santa Ana CA 92701
<br />,
<br />P, 312 - 987.9823 F. 312 -987 -0902
<br />infoccphins.com
<br />*Additional insured locations are often requested by Individual
<br />business owners who have more than one office. Iour coverage is
<br />Underwritten By;
<br />portable, meaning that you are covered at any location forpracticc
<br />Philndelpida Indemnity Insurance Company
<br />tinder the occupation(s) listed on yourpolicy.
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<br />rWn^ «, w
<br />sCover
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<br />Polio #: PHCP081041 I EffeihveDate: 08121/2014 EspirationDate: 03/2112015
<br />THE POLICIES OF INSURANCE LISTED BBLOW II,AVE BEEN ISSUED TO THE INS USED Nt,MED ABOVE FOR THE POLICY PERIOD INDICATED,
<br />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
<br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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<br />Oldl ahl0tiltl {�te>�i�a�?�y��
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<br />y$3
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<br />$1
<br />�, ['t'of�6sloCCnal1Ltt�bili;(3r
<br />million
<br />mllllon
<br />�, �. �,�' >.� • J:;,.�
<br />$1,000,000
<br />$3,000,000
<br />Includ 5 eli rati} brbt P UI &�Vatverry
<br />d1l.tal:dit
<br />;Le yandl?ersonalLlatlh ki „r
<br />N/A
<br />N/A
<br />$1 million
<br />S3 million
<br />” ”: Sti"le'mental Liabili
<br />Unlimited
<br />yiulindted
<br />_
<br />,�.Defepse�xpeirseGobe[ §ge ,;.':.
<br />J_
<br />;Sfdtel.icensluglloa',yd IAVVsngatlou+'ai7efense {
<br />$35,000
<br />$35 000
<br />$15,000
<br />$15,000
<br />ra ', Aesault`C
<br />i ycrgew„ .;
<br />$10,000
<br />$35,000
<br />oslit
<br />b»E3 pen e.;'Bgne'Ht,.? + _„
<br />$5,000/ person
<br />$50,000
<br />w'�,r- tisMedical1x'
<br />ense.Cd `e” e` '
<br />$15,000
<br />$15 000
<br />a FIr9i l d,Coyia ie }
<br />es cxe r ip.tionr ro...•vi sir o n- s :
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<br />k ,/XSFpeci„a£'l '� +iP�:
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<br />City of Santa Ana, its Officers,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />Agents, and Employees
<br />BEFORE TIIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />P.O. Box 1988
<br />IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />Holder has also been added to the
<br />Authorized Representative
<br />policy as an additional insured: **
<br />X Yes/ No
<br />* *If the certificate holder is an
<br />'
<br />ADDITIONAL INSURED, the policy(les)
<br />i
<br />C. Philip Hodson
<br />must he endorsed. A statement on this
<br />certificate does not confer rights to the
<br />certificate holder in lieu of such
<br />endorsement(s),
<br />S
<br />DISCLAIMER: The Certificate of Insurance does
<br />and the certificate holder, nor does it ofRrmatively
<br />�SSygta
<br />htsurer(s), authorized representative or producer,
<br />wage afforded by the policies listed thereon.
<br />
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