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Client # 970697 <br />MEMORANDUM OF INSURANCE <br />Date Issued 08/07/2014 <br />Producer <br />This memorandum is issued as a matter of information <br />Mercer Consumer, a service of <br />Mercer Health & Benefits Administration LLC <br />P.O. Box 14576 <br />only and confers no rights upon the holder. This <br />memorandum does not amend, extend or alter <br />coverages afforded by the Certificate listed below. <br />Des Moines, IA 50306 -3576 <br />1- 800 - 503 -9230 <br />Company Affording Coverage <br />Liberty Insurance Underwriters Inc <br />Insured <br />Daniel Achatz <br />4390 Monte Verde <br />Pomona CA 91766 <br />This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, <br />not withstanding any requirement, term or condition of any contract or other document with respect to which this <br />memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the <br />terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by aid claims. <br />Type of Insurance <br />Certificate Number <br />Effective Date <br />Expiration Date <br />Limits <br />Professional Liability <br />RehabProf SE <br />AHY- 752423001 <br />08/08/2014 <br />08/08/2015 <br />Per Incident/ <br />Occurrence <br />$1,000,000 <br />Rehabilitation Counselor <br />Annual Aggregate <br />$3,000,000 <br />PROOF OF INSURANCE <br />Memorandum Holder: <br />Should the above describe Certificate be cancelled <br />PROOF OF COVERAGE ONLY <br />before the expiration date thereof, the issuing company <br />ill endeavor to mail 30 days written notice to the <br />Memorandum Holder named to the left, but failure to <br />WIPE .t? A� FORM <br />q� V.&t1A/V-- <br />mail such notice shall impose no obligation or liability <br />of any ]rind upon the company, its agents or <br />presentatives. <br />Laura A,• Rossrllt <br />.Assistlilit City AttOrTley <br />Authorized Representative <br />Mark Brostowitz <br />Mercer Consumer, a service of Mercer Health & Benefits Administration LLC. In CA d /b /a Mercer Health & Benefits Insurance Services LLC. CA Lic.# OG39709 <br />