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Certificate of Insurance (Proof of Coverage) Date Issued: 8/22/2014
<br />THIS CERTIFICATE IS ISSUED AS A NIATTER Or INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE
<br />HOLDER, THIS CERTIFICATE DOES NOT AMEND. EXTEND. OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Insured Name nnd:1llailln Addres$�`:
<br />:Pro
<br />ram Admil %strator.`: =:`
<br />Wesley A Bosch
<br />Administered By:
<br />CPR and Associates
<br />711 S. Suite 205
<br />1000 E Santa Ana Blvd Suite 200
<br />Chicago, L 60605
<br />Santa Ana CA 92701
<br />Ana,
<br />987.98 3 F. 2-9
<br />P, 312. 987.9823 F. 312 -987 -0902
<br />Info@cphins.com
<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, nieatdng that you are covered at any locatlon forpractice
<br />Philadelphia Indemnity Insurance Company
<br />tinder the occupadon(s) listed on your policy.
<br />Pollc #: PHCP081041 Effective Date: 08/21/2014 Expiretionllate; 08/21/2015
<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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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<br />S�Ailii` £fat�ll['1\AV Sava r
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<br />_.'n:`i(Tonal nntotrtitpgrp7[icYYf�l) w
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<br />S 1 million
<br />$3 million
<br />4�x uujs Pt ofesg[pnal Llabdlfy,>
<br />" `"omme�c�al,�iieral Ltai3111,h`
<br />$1,000,000
<br />$3,000,000
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<br />FAIL Li0ffity, P {r'e S Va e
<br />Ni
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<br />,:rl:,'e t {iand;�ersonalfLta.. i Kw
<br />N/A
<br />N/A
<br />"'e iq .Pyp ;ert Covert
<br />$l million
<br />S3 million:
<br />r
<br />S.0 7etnenfalLtaliil ,, `tt, % >r.
<br />As �
<br />Unlimited
<br />Unlimited
<br />SiatyY ,censln6Bot};Yil>r4v�sf�lgi!tio Defenyf (.
<br />$35,000
<br />$35,000
<br />1
<br />$15,000
<br />Assaul fCoer *rge, t "`
<br />$15,000
<br />1.Z
<br />$10,000
<br />$35000
<br />tiotiE dnsee4eiit�a`+ ,,,
<br />$5,0001 ersun
<br />$50000
<br />�'�xrt. >t ±iVTedecal',Ez ensGCt:G`erp e vs'' .fe :
<br />$15000
<br />$15,000
<br />is s,;F "Flrsi'- AdCoyera'e`v,h,"s
<br />Description/Special Provisions:
<br />a� rya ✓ rt €' n 3 I. sy
<br />_.m..�
<br />City of Santa Ana, its Officers,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />Agents, and Employees
<br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />P.0. 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 />l
<br />* *[f the certificate holder Is an
<br />ADDITIONAL INSURED, the pollcy(les)
<br />C. Philip Hodson
<br />must be endorsed. A statement on this
<br />certificate does not confer rights to the
<br />certificate holder in lieu of such
<br />eudorsement(s),
<br />Cj
<br />DISCLAIMER: The Certificate of Insurance does
<br />and the certificate holder, nor does it nffirmatively
<br />01S 0 `
<br />iusurer(s), authorized representative or producer,
<br />:rage afforded by the policies listed thereon.
<br />
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